Postgraduate Education Corner

Pulmonary and Critical Care Pearls

A 38-Year-Old Welder With Dyspnea and Iron Overload

Physical Examination

His vital signs were as follows: BP, 150/100 mm Hg; heart rate, 78 beats/min; respiratory rate, 14 breaths/min; temperature, 98.3°F; and arterial oxygen saturation, 98% while breathing room air. His physical examination was normal except for Velcro-type crackles in both lung bases.

Laboratory Findings

Laboratory values at presentation showed a hematocrit of 50.4% with a hemoglobin concentration of 16.8 g/dL. Ferritin level was 1,634 ng/mL, and iron level was 169 μg/dL. Transferrin saturation was 62% (normal range, 11 to 46%). The patient had a normal WBC and platelet count. His coagulation studies, liver function test, and kidney function test findings were within normal limits. Blood glucose levels and urinalysis findings were normal as well.

Pulmonary function tests revealed an FEV₁/FVC

Radiology Findings

Chest radiography was normal, and a high-resolution CT scan of the chest showed bilateral diffuse centrilobular ground-glass nodular opacities (Fig 3).

What is the diagnosis?

Diagnosis: Welder's siderosis (pneumoconiosis siderotica)