A 73-year-old female living in the rural area presented with chronic cough. She had multiple rounded nodules less than 1cm in size in both lungs, and bilateral mediastinal lymphadenopathy in chest images, which could be confused with metastatic cancer. Bronchoscopy did not show bronchial anthracofibrosis, and positron emission tomography (PET) scan showed F-18 fluorodeoxyglucose (18F FDG) uptake. Surgical biopsy histology confirmed that the nodule was anthracofibrosis and the lymph node was reactive hyperplasia. Pulmonary function was accompanied by obstructive ventilatory defects, and clinical symptoms and lung function were improved after the use of inhaled corticosteroid and bronchodilator.