Predominant characteristics of idiopathic pulmonary hemosiderosis (IPH), a rare pathology of unknown etiology, are recurrent alveolar hemorrhage, hemoptysis and iron deficiency anemia. No evidence of vascular disorders, infections, cancer, pulmonary embolus, veno-occlusive diseases must also be considered for the diagnosis. A case of chronic IPH with long asymptomatic periods and stages of riacutization with severe dyspnoea, high fever, cough with rusty coloured spitting, asthenia and serious respiratory insufficiency is described. The patient adds to our understanding in one of such riacutization in that she agreed to high-resolution computed tomography (HRCT) testing, in addition to common routine testing. It became possible to underline the importance of HRCT both in the diagnosis of IPH without hemoptysis, awaiting invasive investigations like fiberoptic bronchoscopy and lung biopsy, and in the clinical evaluation of the riacutization. Such analysis leads to forwarding the installment of the most appropriate therapy and to the limitation of fibrotic evolution, when possible.