Chronic beryllium lung disease

54 year old

man who works in the aerospace manufacturing industry.Berylliosis an occupational lung disease that is usually associated with aerospace manufacturing, beryllium mining or manufacturing of fluorescent light bulbs (which used to contain beryllium compounds in their internal phosphor coating).

Wikipedia • CC BY-SA 2.0

Radiopaedia • CC-by-nc-sa 3.0 • de

Chronic beryllium lung disease (CBD) or sometimes just simply known as berylliosis refers to lung changes that can be seen with prolonged exposure to beryllium which is an alkaline earth metal that is used in many different industrial applications.

Epidemiology

It is reported to occur in 2-5% of beryllium-exposed individuals.

Pathology

It is characterized by the development of granulomatous inflammation secondary to a cell-mediated immune response to beryllium.

While it is a multisystem granulomatous disease, it predominantly involves the lungs.

It is sometimes classified as a form of fibrotic pneumoconiosis as well as a type of pulmonary granulomatous disease. Although some authors describe this to represent a hypersensitivity disorder rather than a true pneumoconiosis .

The following criteria need to be present for a definitive diagnosis:

history of beryllium exposure
positive blood or bronchoalveolar lavage (BAL) beryllium lymphocyte proliferation test (BeLPT)
non-caseating granulomas on lung biopsy

Radiographic features

Its imaging features are said to be indistinguishable from pulmonary sarcoidosis .

CT

Reported CT findings have been shown to be variable and non-specific and include:

pulmonary nodularity is considered relatively common
patterns consistent with upper lobe fibrosis
diffuse interstitial fibrosis pattern
traction bronchiectasis
interlobular septal thickening

Mediastinal and hilar lymphadenopathy may also be present in a proportion of cases. In certain situations, ground glass changes may also be seen .

Treatment and prognosis

While there is no cure, commonly adopted management options involve cessation of beryllium exposure and use of systemic corticosteroids . Early treatment with corticosteroids may lead to disease regression and prevent further progression. If fibrosis has developed, the lung damage is irreversible.

History and etymology

It was first described in 1946 by HL Hardy and IR Tabershaw.

Differential diagnosis

Radiographic and pathologic features are indistinguishable from pulmonary sarcoidosis . It may also not be possible to differentiate from other pneumoconioses.