CTICasesDiffuse Pulmonary Nodules of Unknown Etiology (Query Mitral Stenosis with Hemosiderin Deposition)
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Imaging findings
A patient with a history of atrial fibrillation/flutter, chronic anticoagulation, mild renal insufficiency, and peripheral vascular disease showed innumerable tiny, diffuse pulmonary nodules, with a more coalescent area in the right lower lobe. The nodules were of soft tissue attenuation and remained stable over several months, with the patient remaining asymptomatic. No lymphadenopathy was present. The patient also had a pacemaker and signs of possible mitral valve disease (mitral annular calcification, large left atrium), raising suspicion for mitral stenosis.
Key takeaways
This is a perplexing case of stable, diffuse pulmonary nodules of unknown etiology in an asymptomatic patient. The differential included disseminated infection (e.g., coccidioidomycosis) or sarcoidosis, but stability over time made these less likely without symptoms or specific findings. Given the cardiac history and potential for mitral stenosis, hemosiderin deposition or pulmonary ossification secondary to long-standing pulmonary venous hypertension was considered a strong possibility, especially with the coalescent findings in a dependent lung region. The case highlights the challenge of diagnosing diffuse lung nodules when a definitive biopsy is not performed.
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