Patients beryllium disease

Steenland K, Ward E Lung cancer incidence among patients with beryllium disease a cohort mortality study. J Natl Cancer Inst 83 1380-1385, 1991... 

SALTINI, C WINESTOCK, K KIRBY, M PINKSTON, P. CRYSTAL, R.G. (1989) Maintenance of alveolitis in patients with chronic beryllium disease by beryllium-specific helper T cells. New England Journal of Medicine, 320, 1103-1109. 

Kline EM, Moir TW. Long-term experience with beryllium disease a report of twenty patients. AMA Arch Ind Health 1959 19(2) 104-109. 

Fig. 10.1. Chest radiograph in a patient with advanced chronic beryllium disease shows abnormality predominating in the upper lobes, consisting of coarse well-defined nodules, which appear to coalesce in areas. Some of the nodules appear calcified. There is moderate upper lobe volume loss with superior hilar retraction and some anatomic distortion. Hilar enlargement is likely due to a combination of adenopathy and pulmonary arterial enlargement due to pulmonary hypertension...

Fig. 10.3. Computed tomography through the subcarinal region in a patient with chronic beryllium disease shows right hilar enlargement due to adenopathy. A mildly enlarged left subcarinal node (arrow) shows an amorphous pattern of calcification...

Fig. 10.2. Computed tomography image obtained just above the aortic arch in a patient with chronic beryllium disease shows multiple moderately enlarged pretracheal and paratra-cheal nodes (arrows)...

Fig. 10.8. Thin-section computed tomography through the mid-lungs in a patient with chronic beryllium disease shows marked airway wall thickening and mild, predominantly peri-bronchovascular, ground glass abnormality...

Fig. 10.11. Thin-section computed tomography through the upper lungs in a patient with advanced chronic beryllium disease shows multiple predominantly subpleural nodules, with a conglomerate mass on the right, associated with marked distortion and dilation of segmental bronchi. Anterior displacement of the right major fissure indicates significant upper lobe volume loss. An azygos lobe is present...

Chronic fibrotic occupational lung diseases include asbestosis (see p 121), silicosis, coal workers pneumoconiosis, and a few other less common fibrotic lung diseases associated with occupational exposures to such substances as beryllium and hard metal (cobalt-tungsten carbide). These conditions occur after years of exposure and with long latency, although patients may present for evaluation after an acute exposure. Referral for follow-up surveillance is appropriate if exposure is anticipated to be long term. 

Fontenot AP, Falta MT, Freed BM, et al. Identification of pathogenic T cells in patients with beryllium-induced lung disease. J Immunol 1999 163(2) 1019-1026. 

To discriminate beryllium sensitisation (BeS) from CBD, some authors have questioned whether Be-stimulated neopterin production by peripheral blood cells in vitro might be useful in the diagnosis of CBD (Maier et al. 2003). CBD, BeS and Be-exposed workers without disease normal controls and sarcoidosis subjects were compared. CBD patients produced higher levels of neopterin in both unstimulated and Be-stimulated conditions than all other subjects. Using a neopterin concentration of 2.5 ng/ml as a cut-off, Be-stimulated neopterin had an 80% sensitivity and 100% specificity for CBD and was able to differentiate CBD from BeS. These results, nevertheless, have to be confirmed before this test could be used in workplace screening. 

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