Beryliosis:
Clinical:
Beryliosis is a chronic, granulomatous systemic disease (involves liver, skin, etc...) with primary pulmonary involvement that mimics sarcoidosis. Berylliosis is uncommon and only seen in individuals who have industrial exposure (ceramics industry, aerospace, and nuclear weapons production). Chronic beryllium disease develops in up to 16% of exposed workers [2]. The berylium particle is typically inhaled, but a secondary portal of entry is the skin. Patients present with dyspnea, cough, fever, anorexia, weight loss, contact dermatitis, and non-healing ulcers. On histologic analysis, non-caseating granulomas identical to those found in sarcoid are identified. The berylium particles themselves must be located in order to distinguish the disorder from sarcoid. Treatment of symptomatic patients consists of prolonged corticosteroid therapy [2].
Spontaneous pneumothorax occurs in slightly more than 10% of affected patients. An acute form of beryliosis may occur due to acute high exposure which produces a chemical pneumonitis with an acute alveolar pattern on CXR. In this form of the disorder, alveolar wall damage results in an acute pulmonary edema type pattern.
X-ray:
CXR is often normal in early-stage disease [2]. Abnormalities are seen in about 50% of cases and are generally characterized by small nodules or reticulonodular opacities that predominate in the mid and upper lung zones [2]. Moderate nodal enlargement is frequent [2]. The findings produce a pattern indistinguishable from sarcoid. In more advanced disease, coalescence of granulomatous lesions can produce larger masses and interstitial fibrosis and honeycombing are also seen [2].
On CT, the most common finding is small parenchymal nodules (about 57% of cases) distributed along bronchovascular bundles or interlobular septa [2]. Interlobular septal thickening is seen in about 50% of cases [2]. Other findings include ground glass opacities (32%), honeycombing, and conglomerate mass [2]. Hilar or mediastinal adenopathy is observed in about 40% of cases [2].
REFERENCES:
(1) Radiol Clin North Am 1991; Sep. 29(5): p.931-41
(2) Radiographics 2006; Chong S, et al. Pneumoconiosis: comparison of imaging and pathologic findings. 26: 59-77
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
