대한흉부영상의학회 Weekly Chest Cases

Case No : 322 Date 2003-12-27

Courtesy of Kyung Hee Lee, M.D. / Inha University Hospital, Inchon, Korea
Age/Sex 54 / M
Chief ComplaintAbnormality on preoperative chest radiograph for rectal cancer. No thoracic symprom.

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Diagnosis With Brief Discussion

Diagnosis: Welder's pneumopconiosis
Radiologic Findings: Chest PA shows Ill-defined numerous small nodules in both lungs. HRCT scans show diffuse ill-defined centrilobular ground glass nodules in both lungs.
In the histologic evaluation by TBLB, there were intraalveolar accumulation of hemosiderin-laden macrophages, consistent with old pulmonary hemorrhage. He had a occupational history of arc-welder for 10 years.
Brief Review: Arc-welders’ pneumoconiosis is caused by the deposition of iron oxide. Since the original description of the condition in 1936, it has been generally accumed that the disease is a benign one, not associated with respiratory symptoms or fibrosis. Some authors, however, reported respiratory difficulty associated with arc-welding, or histologic findings of emphysema or pulmonary parenchymal fibrosis in arc welders. Here, the rare occurrence of parenchymal fibrosis has been attributed to ingredients other than iron (mostly silica) in welding fumes, based on cases where heavy deposition of iron in lung parenchyma was not associated with pulmonary fibrosis in either a human or in experimental animal model.

Thin-section CT findings of arc-welder’s lung include poorly-defined centrilobular micronodules, branching linear structures, and ground-glass attenuation.
References: 1. Yoshii C, Matsuyama T, Takazawa A, Ito T, Yatera K, Hayashi T, Imanaga T, Kido M.. Welder's pneumoconiosis: diagnostic usefulness of high-resolution computed tomography and ferritin determinations in bronchoalveolar lavage fluid. Intern Med. 2002 Dec;41(12):1111-7.
2. Kalliomaki PL, Sutinen S, Kelha V, Lakomaa E, Sortti V, Sutinen S.. Amount and distribution of fume contaminants in the lungs of an arc welder post mortem. Br J Ind Med. 1979 Aug;36(3):224-30.
Keywords: Lung, Inhalation and aspiration disease, Occupational lung disease,

No. of Applicants : 31

▶ Correct Answer : 10/31, 32.3%

- Annecy Hospital, France Arnaud Gregoire
- CHU Nancy-Brabois, France Denis Regent
- Chungju Hospital, Konkuk University, Korea Chang Hee Lee
- Dong-A University Hospital, Korea Ki-Nam Lee
- Ewha Women's University Hospital, Korea Yookyung Kim
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Jeju Hanmaeum hospital, Korea Kim Kwon Hyoung
- Mallinckrodt Institute of Radiology, USA Jin Mo Goo
- Seoul National University Hospital, Korea Jung-Gi Im

▶ Semi-Correct Answer : 11/31, 35.5%

- Annecy Hospital, France Gilles Genin
- CH Lyon sud, France Xavier Riviere
- CIM Saint Dizier, France JC Leclerc
- Dodoens Ziekenhuis Mechelen, Belgium Ivan Pilate
- Escola Paulista de Medicina, Fleury, Sao Paulo - Brazil Gustavo Meirelles
- Ev. Krkhs. Hubertus, Berlin, Germany Michael Weber
- Ewha Women's University Hospital, Korea Sung Shine Shim
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Gwangmyoung Sung-Ae Hospital, Korea Jiyong Rhee
- Korea University Anam Hospital, Korea Bo Kyung Je
- Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 322 Date 2003-12-27

Discussion

No. of Applicants : 31