History and Physical Examination
The most significant exposure to beryllium occurs in the occupational setting. Obtaining a good occupational history is critical to effective diagnosis. [8] Occupations with the highest potential for exposure to beryllium are those involved with primary production, metal machining, and reclaiming scrap alloys. Other high-exposure occupations are in the nuclear power, aerospace, and electronics industries. The number of industries that use beryllium is continuously expanding and the above list should not be viewed as exclusive.
Beryllium has been used in a wide variety of products, including some bicycles and golf clubs. Individuals using end products that contain beryllium are currently not considered at risk for sensitization or disease. Only if the beryllium component is handled in a way that generates beryllium dust or particles (eg, sanding) would there be a risk.
Due to the use of BeLPT testing to screen workers exposed to beryllium, many cases now are diagnosed very early in the course of the disease, before radiographic or physiologic changes are observed and before symptoms or physical signs develop. Dyspnea, usually of insidious onset, is the most common symptom. Other symptoms include cough, chest pain, arthralgia, fatigue and weight loss. Physical signs include inspiratory crackles on pulmonary auscultation, lymphadenopathy, rash (dermatitis) [9] and hepatosplenomegaly.
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A high-resolution CT scan of the chest showing the typical ground glass appearance in a patient with chronic beryllium disease, or berylliosis.
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A histopathology slide (hematosin and eosin stain) showing the typical well-formed granuloma of chronic beryllium disease, or berylliosis.
