As a result of observations on many of these cases, the following criteria were developed to identify those cases with chronic beryllium disease:

1. documentation of beryllium exposure,

2. presence of beryllium in body tissues or fluids,

3. evidence of lower respiratory tract disease and a clinical course consistent with chronic beryllium disease,

4. radiographic evidence of pulmonary interstitialfibronodular changes,

5. restrictive or obstructive spirometry or reduced carbon monoxide diffusing capacity, and

6. noncaseating granuloma in lung or lymph node biopsy or pulmonary mononuclear cell infiltrates.

To be included as a registry case, the subject needed to satisfy at least four of the six criteria including at least one of the first two.

While the above criteria may be used for a presumptive diagnosis of CBD, to make a definitive diagnosis of CBD, most clinical experts now require evidence of beryllium hypersensitivity along with histopathology on lung biopsy consistent with beryllium disease, as well as a history of exposure to beryllium.

Beryllium disease may be confused with sarcoidosis or other interstitial lung diseases. Individuals who have had exposure to beryllium should receive a thorough assessment of respiratory symptoms, a chest examination, pulmonary function tests, and chest x ray. Some cases may present with a paucity of symptoms and subtle clinical abnormalities.

Pulmonary Function Tests

Patients with CBD usually have a reduced diffusing capacity, often, but not always, with a restrictive pattern onspirometry. Patients with CBD sometimes develop an obstructive impairment due to peribronchial granuloma formation.

Radiologic Studies

The typical radiographic findings in CBD are diffuse infiltrates often accompanied by bilateral hilar lymphadenopathy. The radiographic infiltrates are granular, nodular, linear, or mixed. Coarse interstitial densities indicative of fibrosis, and in rare cases, hyperlucent areas indicative of emphysema, may be seen.

Beryllium Sensitivity Tests