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Diagnosis, Clinical
Characteristics, and Treatment of
Sarcoidosis
Diagnosis
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Diagnosis of
sarcoidosis is firm when chest
radiographic evidence is
accompanied by compatible clinical
features and noncaseating
granulomas on biopsy, with all
other causes of granulomas ruled
out.
-
Biopsy is
indicated for all patients
presumed to have sarcoidosis,
except those with Löfgren’s
syndrome.
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Pathologists
can identify granulomas, but the
diagnosis should not be based on
pathological findings alone.
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A response to
corticosteroid therapy does not
establish the diagnosis of
sarcoidosis.
-
Measurement of
the serum
angiotensin-converting–enzyme
level is an insensitive and
nonspecific diagnostic test and a
poor therapeutic guide.
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For patients
without apparent lung involvement,
FDG PET is useful in identifying
sites for diagnostic biopsy.
-
FDG PET and MRI
with gadolinium detect cardiac and
neurologic involvement. (Caution
in the use of gadolinium is
needed, given the possibility that
nephrogenic fibrosing sclerosis
may develop in patients with
chronic kidney disease.)
-
CT imaging is
unnecessary for most patients with
sarcoidosis. CT is indicated when
the chest radiograph is atypical
for sarcoidosis or when hemoptysis
occurs.
Clinical
characteristics
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Constitutional
symptoms such as fatigue may
predominate.
-
Cardiac
sarcoidosis is much more common
than reported previously and may
cause loss of ventricular function
and sudden death.
-
Cardiac and
neurologic sarcoidosis may occur
without apparent disease activity
in other organs.
-
Chest
radiographic patterns (stages 1,
2, and 3) do not reflect the
chronology of the disease.
Treatment
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Most patients
with sarcoidosis do not require
therapy.
-
There have been
few well-controlled studies of the
use of any therapeutic agent in
patients with sarcoidosis — be
skeptical of anecdotal reports.
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Treatment for
pulmonary sarcoidosis is best
guided by pulmonary-function
studies.
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Deforming
sarcoidal skin lesions are usually
chronic and require prolonged
therapy.
Abbreviations:
FDG PET denotes
18F-fluorodeoxyglucose
positron-emission tomography, MRI
magnetic resonance imaging, and CT
computed tomography.
Related Criteria
Light Criteria for Exudative Pleural Effusion
GINA Classification of Asthma Severity
Indications
for Lung Biopsy
ATS/ERS Criteria for Diagnosis
of Idiopathic Pulmonary Fibrosis (IPF)
in Absence of Surgical Lung Biopsy
More...
References:
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Iannuzzi MC,
Rybicki BA, Teirstein AS.
Sarcoidosis. N Engl J Med. 2007
Nov 22;357(21):2153-65.
[Medline]
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