Berylliosis

Jud W. Gurney, MD, FACR

Key Facts

Terminology

Strong lightweight element with a high melting point, used in alloys in wide variety of industries
- Inhalation causes 2 pulmonary syndromes: Acute chemical pneumonitis and chronic granulomatous lung disease

Imaging Findings

Pattern identical to sarcoidosis; however
- Ground-glass opacities more common
- Lymphadenopathy not as prominent
Resolution: Ground-glass opacities replaced by microcysts or septal lines
Hilar or mediastinal adenopathy (40%), always associated with lung disease
In sarcoidosis, adenopathy typically regresses as lung disease worsens; not seen with berylliosis

Top Differential Diagnoses

Clinical Issues

History of beryllium exposure, latent period of 1 month to 40 years (average 10-15 years)
- 10% of patients with acute disease go on to develop chronic disease
Skin rash, poor wound healing, papular or vesicular rash (itchy)
10% develop renal calculi from hypercalcemia
Beryllium known pulmonary carcinogen; cancer usually develops in patients after acute berylliosis

Axial CECT shows peribronchial nodules

and subpleural nodules

in a pattern identical to sarcoidosis.

Coronal CECT shows peribronchial nodules

mainly in the right mid and lower lung. No adenopathy is present in this patient with berylliosis.

TERMINOLOGY

Abbreviations and Synonyms

Definitions

Beryllium: Strong lightweight element with high melting point, used in alloys in wide variety of industries
- Inhalation causes 2 pulmonary syndromes: Acute chemical pneumonitis and chronic granulomatous lung disease

IMAGING FINDINGS

General Features

Best diagnostic clue
- Pattern identical to sarcoidosis; however
  - Ground-glass opacities more common
  - Lymphadenopathy not as prominent
Patient position/location: Primarily mid lung with tendency to upper lobe fibrosis with chronic disease

CT Findings

Normal in up to 25% with proven disease
Morphology
- Identical pattern to sarcoid
  - Ground-glass opacities more common
- Nodules (65%) > ground-glass opacities (55%) > septal lines (50%)
- Nodules may aggregate into progressive massive fibrosis (PMF) (5%)
- Nodules may calcify
- Upper zonal pleural thickening due to pseudoplaques (aggregation of subpleural nodules)
Distribution
- Nodules lie along bronchovascular bundles, peripheral septa, subpleural lung, and fissures (50%)
- Honeycombing in advanced disease (5%), typically worse in upper lung zones
Evolution
- Successful treatment
  - Ground-glass opacities either resolve over 3 months or
  - Replaced by microcysts or septal lines
Other
- Hilar or mediastinal adenopathy (40%), always associated with lung disease
  - Nodes: May have diffuse or eggshell calcification
  - Intense calcification in 10%