Diagnosis of pulmonary hemosiderosis by MR imaging

Idiopathic pulmonary hemosiderosis (IPH) is an uncommon but devastating disease in children [1]. The radiographic finding of a diffuse alveolar infiltrate [2], together with clinical findings of chronic, nonproductive cough, dyspnea, and irondeficiency anemia, strongly suggest IPH, but open-lung biopsy is usually necessary for definitive diagnosis [1 ]. We present a case of IPH in which MR imaging of pulmonary parenchymal hemosiderin showed a preferential T2 shortening by paramagnetic ferric iron similar to that occurring in evolving intracranial hematomas. This noninvasive diagnosis allowed initiation of therapy and stabilization of the patient’s cardiorespiratory status before lung biopsy. We suggest that in patients whose radiographic and clinical presentations suggest IPH, the MR findings permit sufficient diagnostic confidence to defer invasive maneuvers until the patient is clinically stable.