CTICasesSiderosis and Aluminosis in a Welder
Imaging findings
Chest CT of a welder reveals extremely hyperdense, amorphous mediastinal and hilar lymph nodes. High-resolution lung windows show subtle centrilobular ground-glass nodules and thickening of the small airways, consistent with small airways disease and iron accumulation in alveolar macrophages. Lung biopsy demonstrated a desquamative interstitial pneumonia (DIP)-like reaction with abundant iron-laden macrophages and exposure to aluminum fumes.
Key takeaways
Welders are exposed to a complex mixture of vaporized metals, primarily iron but also aluminum, silica, and others. Welder's siderosis presents with centrilobular micro-nodules due to accumulation of iron-laden macrophages (which can pathologically mimic DIP). Additionally, inhaled metallic dusts accumulate in the hilar and mediastinal lymph nodes via lymphatic clearance, causing them to appear extremely radiodense on CT due to the high atomic numbers of the deposited metals.
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