Diagnosis of Sarcoidosis

Abstract

The diagnosis of sarcoidosis, a systemic granulomatous disease, is based on a compatible clinical-radiological picture and the histological evidence of noncaseating granulomas. Other diseases mimicking sarcoidosis, mostly infections and other granulomatoses, have to be excluded. There is no single test for sarcoidosis, and the presence of granulomas alone does not establish the diagnosis. Symptoms of sarcoidosis are not specific and can be markedly different according to organ involvement and disease course. Respiratory symptoms and fatigue are the most common symptoms at any stage of disease. Histological confirmation is not needed for Löfgren's or Heerfordt's syndrome and asymptomatic bihilar lymphadenopathy. The radiological staging system is still based on chest radiography, and computed tomography is not mandatory for routine follow-up. (18)F-fluorodeoxyglucose positron emission tomography may be of value in special cases. For assessment of lung involvement and follow-up, pulmonary function tests are necessary with vital capacity being the most important single parameter and diffusion capacity the most sensitive. Bronchoscopy with biopsy is the most common procedure for detection of granulomas, when there is no easier biopsy site like skin or peripheral lymph nodes. Endobronchial ultrasonography-guided transbronchial needle aspiration has replaced mediastinoscopy for evaluation of mediastinal and hilar lymph nodes with a high diagnostic yield. Despite numerous studies, no single biomarker can be reliably used for correct diagnosis or exclusion of sarcoidosis. Genetic testing, despite promising advances, has still not been included in routine care for sarcoidosis patients. The long-term prognosis of sarcoidosis depends on the different organ manifestations: Cardiac or central nervous involvement, together with respiratory complications, is critical. A multidisciplinary approach is necessary for comprehensive care of the sarcoidosis patient.

Thoracic Sarcoidosis: Imaging with High Resolution Computed Tomography

“…Radionuclide imaging, in particular 18F-Fluorodeoxyglucose Positron Emission Tomography (18FDG PET) may be helpful to assess activity of the disease [5]. Aim of this study is to assess and evaluate the features of lung parenchymal lesions and mediastinal lymph nodes in thoracic sarcoidosis on HRCT.…”

“…Predominant involvement of hilar and right paratracheal lymph nodes is seen in 50-90% of the patients with mediastinal adenopathy in thoracic sarcoidosis [1,[5][6][7]. The lymphadenopathy in sarcoidosis is usually non-necrotic, bilateral and symmetrical.…”

“…Fibrosis, bullae, cicatricial emphysema and subpleural honey combing represent advanced stage of sarcoidosis and usually involve the upper and mid zones of the lungs with relative sparing of the bases [1,5]. Extensive fibrosis with traction bronchiectasis was seen in 7.5 % (n=03) patients with end stage lung disease.…”

Update on sarcoidosis

“…This evaluation should be conducted at every visit. Some specialists recommend an electrocardiogram at least once on every patient [42] as ECG abnormalities can develop prior to adverse cardiac events [43 & ]. Patients with evidence of cardiac disease should have an urgent evaluation with a cardiologist.…”

Biomarkers in interstitial lung disease: moving towards composite indexes and multimarkers?

“…The clinical diagnosis relies on the histologic identification of non-necrotizing granulomas in biopsied samples, combined with specific clinical, radiologic, and laboratory findings [26]. The importance of a multimodality assessment cannot be understated as nonnecrotizing granulomas are encountered in numerous disease states including berylliosis, lymphoma, and chronic hypersensitivity pneumonitis.…”