电焊工尘肺/铁尘肺
青岛大学医学院附属医院放射科 庞婧 译
Case NO:876
Courtesy Geewon Lee, Ji Won Lee / Pusan National University Hospital
Age/Sex 54 / M
Chief Complaint Dyspnea for several months. Smoking history; ex- smoker
患者男性，54岁。
主诉：呼吸困难数月，有吸烟史，已戒烟。
Diagnosis Arc welder's pneumoconiosis(pulmonary siderosis)
诊断 电焊工尘肺/铁尘肺
Radiologic Findings
影像学表现
Axial HRCT images demonstrate diffuse, multiple small and poorly defined centrilobular nodules in both lungs.
轴位HRCT示双肺弥漫性多发小的散在小叶中心结节，边界不清。
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.
患者为焊接工，于造船厂工作15年。左肺上下叶均行胸腔镜楔形切除活检。取检样本示细支气管中心性含铁血黄素和含铁血黄素巨噬细胞沉积，伴轻度间质纤维化，提示为肺铁沉着症。此外，Tunnel蓝铁染色示肺泡巨噬细胞内铁过载，证实为肺铁沉着症。
Brief Review
简要回顾
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.
肺铁沉着症是由于肺内巨噬细胞氧化铁沉积所致。大多数肺铁沉着症患者见于可能吸入氧化铁微粒的电弧和氧乙炔焊接工人。肺铁沉着症不常伴有肺纤维化和肺功能损伤。暴露因素终止后，影像学异常表现可逆，并可能部分或完全消退。
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.
HRCT可见广泛分布、边界不清的小叶中心型微小结节，其次是分布较为随机的斑片状磨玻璃影。肺气肿常见。CT所示的微小结节为尘斑，后者为沿血管周和支气管周围淋巴管聚集的含尘的巨噬细胞。
References
1. Lucía Flors, Maria L. Domingo, Carlos Leiva-Salinas,Miguel Mazón, Esther Roselló-Sastre, José Vilar.Uncommon Occupational Lung Diseases: High-Resolution CT Findings. AJR 2010;194:W20–W26
2. Bhawna Satija, SanyalKumar, Umesh Chandra Ojha2, Dipti Gothi. Spectrum of high-resolution computedtomography imaging in occupational lung disease. Indian Journal of Radiologyand Imaging 2013; 23: Issue 4