Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
Other diagnostic factors
- disnea de esfuerzo
- tos
- exploración física de tórax normal
- crepitantes durante la auscultación pulmonar
- opresión en el pecho o sibilancias
- espiración prolongada y sibilancias en la auscultación pulmonar
- áreas de matidez en la percusión torácica
- cianosis
- tórax en tonel
- hemoptisis, fiebre o sudores nocturnos
- hipocratismo digital de las manos y los pies
- pérdida de peso
- signos de artritis reumatoide o esclerodermia
- signos de insuficiencia renal (p. ej., aumento de peso, edema, hipertensión)
Risk factors
- exposición laboral a la sílice
- exposición laboral al carbón
- exposición laboral al berilio
- dosis de carbón o sílice inhalados de alta acumulación
- tabaquismo
- ácido glutámico en la posición 69 de la cadena B1 de la molécula HLA-DP (enfermedad crónica por berilio)
- dosis de berilio inhalado de alta acumulación
Diagnostic investigations
1st investigations to order
- radiografía de tórax (posteroanterior y lateral)
- espirometría
- prueba de proliferación de linfocitos de berilio (BeLPT)
Investigations to consider
- biopsia broncoscópica y/o lavado
- exploración de tórax por tomografía computarizada (TC) de alta resolución (HRCT)
- saturación de oxígeno
- gasometría arterial (GSA)
- biopsia pulmonar
- prueba de la tuberculosis (TB)
Treatment algorithm
proteinosis alveolar secundaria aguda (silicosis aguda)
beriliosis aguda
silicosis crónica, pulmón de los trabajadores del carbón o beriliosis crónica
Contributors
Authors
Kenneth D. Rosenman, MD
Professor of Medicine
Division of Occupational and Environmental Medicine
Michigan State University
East Lansing
MI
Disclosures
KDR declares no competing interests.
Peer reviewers
Ware G. Kuschner, MD
Associate Professor of Medicine
Stanford University
Staff Physician
US Department of Veterans Affairs
Palo Alto Health Care System
Palo Alto
CA
Disclosures
WGK declares that he has no competing interests.
Harman Paintal, MBBS
Division of Pulmonary and Critical Care Medicine
Veterans Affairs Palo Alto Health Care System (VAPAHCS)
Palo Alto
CA
Disclosures
HP declares that he has no competing interests.
Francis Thien, MD, FRACP, FCCP
Professor
Box Hill Hospital and Monash University
Victoria
Australia
Disclosures
FT declares that he has no competing interests.
Edward L. Petsonk, MD
Professor of Medicine
Section of Pulmonary and Critical Care Medicine
West Virginia University School of Medicine
Morgantown
WV
Disclosures
ELP declares that he has no competing interests.
Christopher M. Barber, BM, BS, BMedSci, FRCP, MD, AFOM
Respiratory Consultant
Sheffield Teaching Hospitals NHS Foundation Trust
Sheffield
UK
Disclosures
CMB declares that he has no competing interests.
Carl J. Reynolds, MBBS, MRCP, BSc, MSc, PhD, DPMSA
Respiratory Consultant
Honorary Senior Clinical Lecturer
North Middlesex University Hospital
Imperial College London
UK
Disclosures
CJR declares that he has no competing interests.
References
Key articles
Balmes JR, Abraham JL, Dweik RA, et al. An official American Thoracic Society statement: diagnosis and management of beryllium sensitivity and chronic beryllium disease. Am J Respir Crit Care Med. 2014 Nov 15;190(10):e34-59.Full text Abstract
American College of Radiology. ACR Appropriateness Criteria: occupational lung diseases. 2019 [internet publication].Full text
National Institute for Occupational Safety and Health. Health effects of occupational exposure to respirable crystalline silica. Apr 2002 [internet publication].Full text
International Labour Office. Guidelines for the use of the ILO international classification of radiographs of pneumoconioses, revised edition. 2022 [internet publication].Full text
US Occupational Safety and Health Administration (OSHA). Final rule to protect workers from occupational exposure to respirable crystalline silica. Appendix B to §1926.1153 construction standard - medical surveillance guidelines. Jun 2016 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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