Progressive massive fibrosis is a recognized complication of pneumoconiosis secondary to pulmonary fibrosis, with retraction forming conglomerate masses symmetrically in the upper lobes. Idiopathic pulmonary hemosiderosis is known to cause pulmonary fibrosis secondary to recurrent alveolar hemorrhage with deposition of hemosiderin in the interstitium. We present a case in which progressive massive fibrosis developed in a patient with long-standing idiopathic pulmonary hemosiderosis.