대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Courtesy

Samsumg Medical Center, Seoul, Korea

Definitive Diagnosis

Mediastinoscopic Bx

Multiple non-caseating uniform granulomas, suspicious of sarcoidosis

Beryllium exposure by occupational history

Discussion

Chronic beryllium ds

Berylliosis caused by exposure to aerosols, dusts, or fumes of beryllium metal or salts

Systemic granulomatous disease

Histologic features identical to sarcoidosis

Thought to be caused by a specific, cell-mediated hypersensitivity response to long-term exposure to beryllium



Symptoms : Exertional dyspnea (m/c), cough, chest pain


Diagnosis

Suggested by a history of significant exposure to beryllium

Consistent radiographic findings

Abnormal PFT

Confident diagnosis : demonstration of granulomas in tissue, and a proliferative response of lymphocytes obtained by BAL to beryllium (bronchoalveolar lymphocyte transformation test )

Radiographic findings

Small round and reticular opacities that are distributed diffusely in the lungs without zonal predominance(m/c)

Linear scars, bulla, fibrosis predominantly involving the upper lobes

Conglomerate masses similar to those seen in silicosis

Hilar lymphadenopathy : in up to 1/3 of affected patients

Pleural thickening

Keywords

Lung, Mediastinum, Non-infectious inflammation, Occupational lung disease, chronic beryllium disease,