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So My Koo, M.D.1, Sung Woo Park, M.D.1, Jong Sook Park, M.D.1, June Hyuk Lee, M.D.1, An Soo Jang, M.D.1, Do Jin Kim, M.D.1, Choon Sik Park, M.D.1
, Sang Hyun Paik, M.D.2, Eun Suk Koh, M.D.3
, Sang Hyun Paik, M.D.2, Eun Suk Koh, M.D.3
Abstract
Pulmonary siderosis is a pneumoconiosis caused by chronic iron inhalation. A diagnosis of pulmonary siderosis is based on a patient history of iron inhalation, on chest radiographic findings, and on accumulation of iron oxide in macrophages within the lung. A typical radiographic finding of pulmonary siderosis includes ill-defined micronodules that are diffusely distributed in the lung. We experienced a 52-year-woman with a 1.3×1.5-cm mass in the left upper lobe with multiple nodules in both lungs. Because the radiographic findings were atypical, we conducted a video-assisted thorascopic lung biopsy procedure to exclude the diagnosis of metastatic lung cancer. After confirming iron deposition in the lung tissue and knowing the patient's occupational history of welding iron, we concluded that this was a case of pulmonary siderosis.
Figures and Tables
Figure 1
(A) Chest PA shows multiple ill defined irregular nodules in both lungs. (B) Chest CT scan with lung window shows 1.3×1.5 cm sized irregular large nodule (arrowhead) in left upper lobe and multiple round nodules (arrows) in both upper lobes. (C) Chest CT scan with mediastinal window shows 1.3×1.5 cm sized irregular enhancing nodule (arrowhead) in left upper lobe. (D) Chest CT scan with lung window reveals multiple small round nodules (arrows) in left upper lobe and left lower lobe. (E) Follow-up chest CT scan after 4 months shows no interval change of multiple small nodules (arrows).
Figure 2
(A) Gross photograph shows ill-defined grayish yellow nodular lesion. (B) Inflammatory fibrotic nodules with brown pigmentation (H&E stain, ×10). (C) Numerous macrophages with bright blue cytoplasmic pigmentation (Prussian blue stain, ×200). (D) Abscess with central colonizing aspergillosis (H&E stain, ×40).
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