Tuberc Respir Dis.  2011 Jan;70(1):58-62.

A Case of Pulmonary Siderosis Mimicking Metastatic Lung Cancer

• Koo SM
• Park SW
• Park JS
• Lee JH
• Jang AS
• Kim DJ
• Park CS
• Paik SH
• Koh ES

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 1.3x1.5-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.

Keyword

Pulmonary hemosiderosis; Lung Neoplasms; Neoplasm Metastasis; Multiple Pulmonary Nodules; Aspergilloma

MeSH Terms

Biopsy
Ferric Compounds
Hemosiderosis
Humans
Inhalation
Iron
Lung
Lung Diseases
Lung Neoplasms
Macrophages
Multiple Pulmonary Nodules
Neoplasm Metastasis
Pneumoconiosis
Siderosis
Thorax
Welding
Ferric Compounds
Hemosiderosis
Iron
Lung Diseases

Figure

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  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).

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  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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