대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Pulmonary Hemosiderosis associated with Mitral Stenosis

Radiologic Findings

Chest radiograph shows numerous tiny nodules in both lungs. Pulmonary vascular cephalization, double contour overlying the right atrial shadow and effacement of the cardiac waist with normal cardiac size are noted. HRCT scan shows multiple nodules randomly distributed in both lungs. These are suggested pulmonary hemosiderosis possibly due to long-standing mitral stenosis. On echocardiography, severe mitral stenosis was noted with thrombi in enlarged left atrium. Cerebral infarction was thought to be due to emboli from LA thrombus. The patient was diagnosed as having mitral stenosis several years ago.

Brief Review

Typical radiographic findings in mitral stenosis include pulmonary vascular cephalization; interstitial, perivascular, and occasionally alveolar pulmonary edema; diffuse alveolar hemorrhage; hemosiderosis; and pulmonary ossification. Pulmonary hemosiderosis (deposition of blood pigments in the interstitial tissues) secondary to mitral disease is a frequent pathologic finding, but is not commonly recognized as such on chest films. If sufficient amounts of these deposits are present, they are visible roentgenographically as fine granular or miliary shadows throughout the lungs. They may become large enough to produce nodular densities ranging from 2 to 5 mm in diameter. The appearance of the lungs may resemble that noted in miliary tuberculosis or early nodular silicosis. Small, ill-defined nodules or coarse reticular opacity can be seen.

References

1. Kevin Woolley, Paul Stark. Pulmonary parenchymal manifestations of mitral valve disease. Radiographics 1999; 19:965-972.
2. John H. Juhl, Andrew B. Crummy, Janet E. Kuhlman. Paul and Juhl`s essentials of radiologic imaging. 7th ed. Linppincott-Raven, Philadelphia, 1998;1231-1234

Keywords

Lung, Metabolic and storage lung disesae,