Hemosiderosis due to various heart conditions deserves particular attention here, especially as our patient presented with severe mitral regurgitation. The pulmonary parenchymal manifestations of cardiac disorders are the consequence of either elevated postcapillary pressures (eg, mitral stenosis or congestive heart failure), or abnormal blood flow (eg, mitral regurgitation). Typical radiographic findings in mitral stenosis are as follows: cephalization of pulmonary vasculature; interstitial or alveolar edema; alveolar opacities representing diffuse alveolar hemorrhage; and, in patients with longstanding disease, secondary pulmonary hemosiderosis and/or diffuse pulmonary ossification. In patients with mitral regurgitation, the clinical picture depends on the acuity of onset of the valvulopathy. In acute-onset mitral regurgitation (eg, due to endocarditis, trauma, dysfunction related to ischemia, infarction, or rupture of the chordae tendinae), the abrupt occurrence of symmetrical pulmonary edema is typical. In contrast, in patients with chronic valvular disease (eg, myxomatous degeneration, rheumatic fever, mitral annulus calcification, annulus dilatation secondary to left ventricular cavity enlargement, and periprosthetic valve leak), a more insidious disease is usual, with progressive eccentric left ventricular hypertrophy, and, ultimately, enlargement and failure. Asymmetric right-upper lobe pulmonary edema due a regurgitant jet toward the pulmonary veins has been described in approximately 10% of cases. Because our patient showed no evidence of asymmetric pulmonary edema and episodes of hemoptysis antedated the development of mitral insufficiency, we considered that valvular disease was unlikely to be the cause of pulmonary hemosiderosis.