Baritosis is used to describe the accumulation of barium in the lungs in the setting of occupational exposure. Although barium is a very toxic mineral when introduced to the body via the gastrointestinal system, patients experience minimal or no symptoms when inhalation of this particle occurs. Cessation of exposure results in rapid resolution of clinical and radiographic findings.
Occupational exposure to barium and its numerous forms (most important being barium sulfate) through inhalation was described throughout the 20th century as an asymptomatic form of a nonfibrotic and uncommon type of pneumoconiosis. [1] [2] Manufacturing of lithopone, a white pigment composed primarily of barium sulfate, as well as arc welding and manufacture of paints, paper, glass, rubber, electronic components (in the form of barium titanate) can be the source of this mineral [2] [3]. Consequently, workers (predominantly males) involved in these industries may inhale significant amounts of barium, but very few reports have addressed symptomatic patients in whom a mild cough was reported as the only complaint [2] [3]. In fact, abnormal clinical findings accompanied by an inability to work and frequent leave of absence, as well as impaired lung function, is never reported if baritosis alone is identified. For this reason, it is classified into the group of "benign pneumoconiosis" [3]. Moreover, even short cessation of exposure to barium dust can result in complete resolution of radiographic findings, which are often the only evidence of this condition [3]. However, baritosis may concomitantly develop with other more dangerous types of occupational lung disease, such as asbestosis, silicosis, berylliosis, and coal worker pneumoconiosis. In such disorders, progressive decline in respiratory function accompanied by a cough, hemoptysis, and dyspnea is frequently noted, especially if the diagnosis is made after years or decades of exposure [1]. The chronic exposure to barium can lead to the presentation of symptoms like a dry cough, cough with expectoration, wheezing, shortness of breath, sniffing and nasal irritation.
Because signs and symptoms of baritosis are virtually non-existent, the diagnosis can often be made only after the use of radiographic findings supported by patient history that will confirm exposure to barium. Plain radiography is a useful initial method that can detect fine nodular lesions and small ring-shaped shadows that point to deposition of dust in the alveoli and bronchioles [2]. Computed tomography (CT), however, is considered as a superior method for diagnosing occupational lung diseases, and extremely dense opacities on high-resolution CT in the basal segments of lower lobes are most important findings that suggest baritosis [4]. A distinction from other types of pneumoconiosis can be made based on the absence of fibrosis, which is typical for asbestosis, silicosis and other more severe forms [2] [3].