대한흉부영상의학회 Weekly Chest Cases

Case No : 876 Date 2014-08-11

Courtesy of Geewon Lee, Ji Won Lee / Pusan National University Hospital
Age/Sex 54 / M
Chief ComplaintDyspnea for several months. Smoking history; ex- smoker

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Diagnosis With Brief Discussion

Diagnosis: Arc welder's pneumoconiosis (pulmonary siderosis)
Radiologic Findings: Axial HRCT images demonstrate diffuse, multiple small and poorly defined centrilobular nodules in both lungs.
The patient had been a welder in a shipyard for 15 years. VATS wedge resectional biopsy of the left lower lobe and left upper lobe was performed. Resected specimen demonstrated bronchiolocentric deposition of hemosiderin pigments and hemosiderin-laden macrophages, associated with mild interstitial fibrosis, suggestive of SIDEROSIS. In addition, Tunnel blue iron stain showed marked iron overload in alveolar macrophages, confirming SIDEROSIS.
Brief Review: 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.
HRCT shows widespread ill-defined small centrilobular nodules and, less commonly, patchy areas of ground-glass attenuation without zonal predominance. Emphysema is often seen. The micronodules on CT correspond to dust macules, which are collections of dust-laden macrophages aggregated along the perivascular and peribronchial lymphatic vessels.
References: 1. Luc
Keywords: Lung, Inhalation and aspiration disease, Occupational lung disease,

No. of Applicants : 79

▶ Correct Answer : 3/79, 3.8%

- Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim

▶ Correct Answer as Differential Diagnosis : 10/79, 12.7%

- Kyoto University , Japan Akihiko Sakata
- Niigata City General Hospital , Japan Takao Kiguchi
- The University of Tokyo Hospital , Japan Takeyuki Watadani
- Shiga University of Medical Science , Japan Akitoshi Inoue
- National Hospital Organization Okinawa Hospital , Japan Yasuji Oshiro
- Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
- Asan Medical Center , Korea (South) Hyung Jung Koo
- SNUH , Korea (South) Eui Jin Hwang
- Oita University , Japan Haruka Sato
- Onomichi municipal hospital , Japan Toshiyuki Komaki

▶ Semi-Correct Answer : 1/79, 1.3%

- IRSA La Rochelle , France Denis Chabassiere

대한흉부영상의학회 Korean Society of Thoracic Radiology

Cases by Disease Category

Case No : 876 Date 2014-08-11

Discussion

No. of Applicants : 79