by Carlo Raj, MD

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    00:00 Let's going through a second type is a Berylliosis.

    00:03 Who is your patient here? Well, in that modern era, we have a patient that might be working in well, high tech industries.

    00:11 So electronic manufacturing industries Berylliosis when NASA was a big deal in the US, and aerospace and all that was a big deal, Well, berylliosis was something that maybe perhaps patient was developing berylliosis.

    00:27 This is our second example of a pneumoconiosis and all pneumoconiosis come under the category of restrictive lung disease.

    00:36 That's where we are.

    00:37 I'm going to do this every single time.

    00:39 So if aerospace, ceramic, we have electronic manufacturing industries, that's huge nowadays.

    00:45 Now, here, please highlight in your mind that this is the upper lobe that's involved.

    00:52 What about the roofer? The roofer asbestos, lower lobe, Berylliosis, upper lobe.

    01:00 Next, look at this.

    01:02 It's a granulomatous type of histology, with occasional responsive glucocorticiods very similar to whom? There you go, sarcoidosis.

    01:12 So, you tell me, sarcoidosis, who's your the patient most likely? A young African American female.

    01:20 There is going to be bilora lymphadenopathy that non-case any type of granuloma, non-case any granuloma that you would find, and sarcoid could be in other organs.

    01:28 What are they? Maybe the skin, maybe the liver, maybe the intestine, and so forth.

    01:32 Right? And sarcoid maybe there is increased production of ACE and might be increased production of when I call 1-alpha-hydroxylase those things are not present here.

    01:43 And on the shin, on the front of the leg, and patient with sarcoid, what are you going to find? Ough! The patient is going to be a little bit of pain. Why? And you take a look at it. It looks red.

    01:55 And its erythema nodosum.

    01:58 Erythema nodosum.

    01:59 You don't find that here either.

    02:01 You see how easy it is for you to differentiate one from the other? You just need to spend time with the differentials, and you'll be good.

    02:08 Who is the patient berylliosis? Oh, occupational hazard.

    02:11 There you go.

    02:13 Hilar lymphadenopathy.

    02:15 Well, that once again, it's non-specific.

    02:16 It's once again similar to sarcoid.

    02:19 You stick to those facts here that you see that is going to differentiate one from the other Second type of pneumoconiosis.

    02:28 Berylliosis is what that is.

    02:30 Let's go into a third type.

    02:32 Our third type is coal worker. Be very careful.

    02:35 Do not get your coal worker confused with your asbestos.

    02:38 Is that clear? And the fourth type, we'll take a look at silica.

    02:40 so what I would recommend that you do is every so often, knockout maybe one or two every time you come and see me, Hmm.

    02:47 So you're knockout "Oh, I get my asbestos completely down." Okay, great.

    02:51 Who is my exposure? Well, maybe environmental, or non-environmental.

    02:54 Okay, fine.

    02:55 You got those occupations.

    02:57 You got the ferruginous body and the fibers done.

    02:59 You're good to go.

    03:00 Maybe take a look at berylliosis, real quick.

    03:01 Ah, stop, pause, take a break, maybe go back and study something else.

    03:06 Do some questions.

    03:07 And then come back, and take a look at coal worker, and move on.

    03:10 There's going to be four major ones.

    03:11 And coal worker, obviously this patient is working in a mine.

    03:15 In a mine that then get exposed to anthracotic particles, Right, carbon particles.

    03:21 So black lung disease, literally what it is? What color is coal? Have you seen coal? It's black.

    03:27 So that black carbon is what you're breathing in.

    03:30 So therefore, you call this whats known as sooty air, right? So when you're burning coal, it's rather sooty.

    03:37 Can we say, quote unquote take a look at the statement here, "Black lung disease, what we call it due to exposure to anthracotic." Well, whatever particle that you then get into your lung, I guess it was going to come in and have a feast, the macrophages, correct.

    03:52 And so therefore, for example, if our hemosiderin-laden macrophages, that's not what this is. This is carbon.

    03:59 So this is carbon-laden macrophages.

    04:01 So use common sense in terms of well, if the phagocytic cells are appearing, what does it actually trying to eliminate here? It's the carbon.

    04:10 Urban areas with city air, upper lobe involvement.

    04:14 Ah, once again, let me ask you, Asbestos, where was it? The roofer? The bottom portion of the lobe, right? The basal portion is upper.

    04:25 Then asymptomatic.

    04:26 Now, this is huge.

    04:28 That statement, don't just run through this.

    04:31 Asymptomatic, really? I have a patient black lung disease and I'm finding anthracotic particles and Dr. Raj, you're telling me this asymptomatic? That's exactly what I'm telling you. Hmm.

    04:42 So what point are you worried about this patient going to severe disease and resulting perhaps potentially in right sided heart failure? Oh, it's called progressive massive fibrosis.

    04:55 Isn't that kind of take you back to the good old days when you are referring to restrictive lung disease, right? So you go back to your comfort zone? Well, you know, fibrosis to you means automatically non-compliance, a very stiff lung, and therefore we have restrictive lung disease.

    05:12 This is where things become really dangerous for the patient.

    05:15 But if you find that you're lung to be black, and there is it fibrosis and we are no evidence of it.

    05:20 It's asymptomatic.

    05:22 But you tell the patient, "Please be careful.

    05:24 You might want to start thinking about changing your job?" And this is what's going to happen.

    05:29 Because how old are these patients that you should go into mines? If I was an 18 year old boy.

    05:35 And there was a company that came to me and said, "Hey, little boy, I'll give you $80,000 per year, if you want to come in and work in a mine." Oh, that sounds mighty tempting.

    05:48 Sure it does.

    05:49 So therefore, don't you feel a little invincible? Perhaps.

    05:53 So meaning to say, that you want to understand who your patient is, and how they might resist and they might even say in the office.

    05:59 "Yes, Doc. Yes, Doc. I'm going to change my job. I change my job." Two years have gone by, More black lung disease, more fibrosis.

    06:08 See what I'm saying? And once again, what if they're smoking? If they're smoking then you get into all kinds of other issues as well.

    06:15 And that occurs more common than you would think.

    06:18 Continue.

    About the Lecture

    The lecture Berylliosis by Carlo Raj, MD is from the course Occupational Lung Diseases.

    Included Quiz Questions

    1. Berylliosis involves the upper lobes of the lungs.
    2. Berylliosis involves the lower lobes of the lungs.
    3. Berylliosis does not respond to steroids.
    4. Nongranulomatous inflammation is characteristic of berylliosis.
    5. Hilar lymphadenopathy is pathognomonic of berylliosis.
    1. Presence of progressive massive fibrosis.
    2. Absence of progressive massive fibrosis.
    3. Increased exposure to ceramics and metal alloys.
    4. Increased exposure to electronic manufacturing industries.
    5. Absence of granulomatous inflammation.

    Author of lecture Berylliosis

     Carlo Raj, MD

    Carlo Raj, MD

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