Chronic beryllium lung disease
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.
It is reported to occur in 2-5% of beryllium-exposed individuals.
It is characterised by the development of granulomatous inflammation secondary to a cell-mediated immune response to beryllium.
While it is a multisystem granulomatous disease, it predominantly involving 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 7.
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
Reported CT have been shown to be variable and nonspecific and include:
- pulmonary nodularity is considered relatively common 1,2,6
- patterns consistent with upper lobe fibrosis 1
- diffuse interstitial fibrosis pattern 1
- traction bronchiectasis 2
- interlobular septal thickening 2
Mediastinal and hilar lymphadenopathy may also be present in a proportion of cases. In certain situations, ground glass changes may also be seen 3.
Treatment and prognosis
While there is no cure, commonly adopted management options involves cessation of beryllium exposure and use of systemic corticosteroids 4. Early treatment with corticosteroids may lead to disease regression and prevent further progression. If fibrosis has developed, the lung damage is not reversible.
History and etymology
It was first described in 1946 by HL Hardy and IR Tabershaw.
- 1. Harris KM, McConnochie K, Adams H. The computed tomographic appearances in chronic berylliosis. Clin Radiol. 1993;47 (1): 26-31. Pubmed citation
- 2. Hansen M, Kauczor HU, Kelbel C et-al. [Chronic pulmonary berylliosis: imaging with high-resolution computerized tomography]. Aktuelle Radiol. 1995;5 (3): 149-51. Pubmed citation
- 3. Naccache JM, Marchand-Adam S, Kambouchner M et-al. Ground-glass computed tomography pattern in chronic beryllium disease: pathologic substratum and evolution. J Comput Assist Tomogr. 2003;27 (4): 496-500. Pubmed citation
- 4. Sood A. Current treatment of chronic beryllium disease. J Occup Environ Hyg. 2009;6 (12): 762-5. doi:10.1080/15459620903158698 - Free text at pubmed - Pubmed citation
- 5. Sharma N, Patel J, Mohammed TL. Chronic beryllium disease: computed tomographic findings. J Comput Assist Tomogr. 2010;34 (6): 945-8. doi:10.1097/RCT.0b013e3181ef214e - Pubmed citation
- 6. Newman LS, Buschman DL, Newell JD et-al. Beryllium disease: assessment with CT. Radiology. 1994;190 (3): 835-40. Pubmed citation
- 7. Aronchick JM. Chronic beryllium disease. Radiol. Clin. North Am. 1992;30 (6): 1209-17. Pubmed citation
- 8. Santo Tomas LH. Beryllium hypersensitivity and chronic beryllium lung disease. Curr Opin Pulm Med. 2009;15 (2): 165-9. doi:10.1097/MCP.0b013e3283218341 - Pubmed citation
- 9. Maier LA. Genetic and exposure risks for chronic beryllium disease. Clin. Chest Med. 2003;23 (4): 827-39. Pubmed citation
- 10. Hansell DM, Lynch DA, McAdams HP et-al. Imaging of Diseases of the Chest. Mosby. ISBN:0723434964. Read it at Google Books - Find it at Amazon
Interstitial lung disease
interstitial lung disease
- drug-induced interstitial lung disease
- hypersensitivity pneumonitis
idiopathic interstitial pneumonia (mnemonic)
- acute interstitial pneumonia (AIP)
- cryptogenic organising pneumonia (COP)
- desquamative interstitial pneumonia (DIP)
- idiopathic nonspecific interstitial pneumonia (NSIP)
- idiopathic pleuroparenchymal fibroelastosis
- lymphoid interstitial pneumonia (LIP)
- respiratory bronchiolitis–associated interstitial lung disease (RB-ILD)
- usual interstitial pneumonia / idiopathic pulmonary fibrosis (UIP/IPF)