대한흉부영상의학회 Weekly Chest Cases

Case No : 710 Date 2011-06-07

Courtesy of Joo Hwa Myong MD, Myung Hee Chung MD. / Bucheon St. Mary’s hospital, The Catholic University of Korea.
Age/Sex 43 / M
Chief Complaintchronic cough, occupational history for 20 years

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Figure 1

Diagnosis With Brief Discussion

Diagnosis: Arc welder’s pneumoconiosis (Pulmonary siderosis)
Radiologic Findings: Chest radiograph shows diffuse ill-defined, small nodules in the whole lung fields. Thin-walled cavities, proved as mycobacterium kansasii are noted in the left upper lobe. Lung CT scans (Fig. 1~3) show multiple small and poorly defined centrilobular nodules of ground glass opacity (GGO) in the whole lung fields. Patchy GGO and low attenuation areas are seen in the left lower lobe. A lung biopsy specimen (x400) (Fig 4) shows numerous iron containing macrophages within alveolar spaces. Prussian blue iron stain (Fig. 5) shows marked iron overload in alveolar macrophages, pathologic confirmation of siderosis (x400).
Brief Review: Arc-welders pneumoconiosis is caused by chronic inhalation of inorganic dust fumes during the weldering procedure. Siderosis is caused by the accumulation of iron oxide in macrophages within the lung. Most cases of siderosis are seen in electric-arc and oxyacetylene welders who may inhale finely divided particles of iron oxide. Siderosis is not usually associated with fibrosis or functional impairment. The radiologic abnormalities are reversible and may resolve partially or completely after exposure ceases. Typical HRCT findings consisted of diffuse, ill-defined centrilobular micronodules (55~71%) that are most prominent in the middle third of the lungs in the perihilar regions; some of these had a fine branching appearance. Emphysema was seen, likely related to smoking. Focal areas of consolidation may appear very high in attenuation due to the presence of iron. In another study, less commonly patchy area of ground glass opacities were seen without zonal predominance. Pneumothorax may occur. The micronodules on CT correspond to dust macules, which are collections of dust-laden macrophages aggregated along the perivascular and peribronchial lymphatic vessels. Inhaled iron with silica results in silicosiderosis. Serum ferritin concentrations were elevated (>240 ng/ml), and ferritin concentration in bronchoalveolar lavage fluid were higher in welder’s pneumoconiosis than in an exposed control group.
References: 1. Masanori Akira. High-resolution CT in the evaluation of occupational and environmental disease. Radiologic Clinics of North America. 2002;40(1):43-49
2. Han DH, Goo JM, Im JG, et al. Thin-section CT findings of arc-welders’ pneumoconiosis. Korean J Radiol 2000;1:79-83
3. Gen Yamada, Tomofumi Igarashi, Hajime Sonoda, et al. Use of Bronchopulmonary lavage for eliminating inhaled fume particles from a patient with arc welder’s lung. Internal Medicine 1998;37:962-964
4. Fatma Fidan, Hidir Esme, Mehmet Unlu, et al. Welder’s lung associated with pneumothorax. J Thorac Imaging 2005;20:120-122
5. Lucia Flors, Maria L. Domingo, Carlos Leiva-Salinas, et al. Uncommon occupational lung disease: High-resolution CT findings. AJR 2010;194:W20-W25
Keywords: lung, inhanlation, Occupational lung disease,

No. of Applicants : 123

▶ Correct Answer : 33/123, 26.8%

- Hangang sacred heart hospital , Korea (South) You Mie Han
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Chung-Nam National University Hospital , Korea (South) KI-TAE HAN
- 紐吏蹂 , Korea (South) Yongsuk Jang
- Inha University Hospital , Korea (South) Ju Won Lee
- Chaeil Clinic , Korea (South) Sunkyung Lim
- Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae Wook Yeh
- Youngdong Hospital , Korea (South) Sang Min Lee
- Saga University , Japan Ryoko Egashira
- Catholic medical center , Korea (South) hyuna kim
- Fukuyama daiichi Hospital , Japan Mototsugu Saeki
- James Paget Hospital , U.K , United Kingdom nabil mahmood
- Japanese Red Cross Society Himeji Hospital , Japan Yuichiro Kanie
- Az Osp Santa Maria Terni , Italy angelo carloni
- IRSA La Rochelle France , France Denis Chabassiere
- Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
- SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
- Onomichi municipal hospital , Japan Hirofumi Mifune
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- IRSA , France jean-luc BIGOT
- Asan Medical Center , Korea (South) Hye Jeon Hwang
- Seoul St Mary Hospital , Korea (South) Chaehun Lim
- Soon Chun Hyang, Seoul , Korea (South) Yoo Na Kim
- Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
- Kizawa Memorial Hospital , Japan Yo Kaneko
- Mallinckrodt Institute of Radiology , United States Naganathan Mani
- Saint Malo , France jean-baptiste Noel
- All India Institute of Medical Sciences , India Ashish Gupta
- Beaulieu clinic Geneva , Switzerland gilles GENIN
- Okayama university , Japan Mayu Uka
- Kobe City Medical Center General Hospital , Japan Hitomi Nagano

▶ Correct Answer as Differential Diagnosis : 9/123, 7.3%

- Saga University , Japan Tetsuya Kondo
- CHRU lille , France manuel toledano
- Onomichi municipal hospital , Japan Ryotaro Kishi
- NDMVP Nashik , India Imran Jindani
- Goa Medical College , India Paresh Desai
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- Mallinckrodt Institute of Radiology , United States Travis Henry
- Shree Diagnostics , India amol jagdale

▶ Semi-Correct Answer : 8/123, 6.5%

- SMC , Korea (South) Yi Kyung Kim
- Armed Forces Yangju Hospital , Korea (South) Ho-Joon Lee
- Onomichi Municipal Hospital , Japan Takuro Fushimi
- Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
- Istanbul , Turkey Armagan Sarac
- PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- Asan Medical Center , Korea (South) Sanghyun Choi
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 710 Date 2011-06-07

Discussion

No. of Applicants : 123