Diagnosis, Clinical Characteristics, and Treatment 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.
indicated for all patients presumed to have
sarcoidosis, except those with Löfgren’s syndrome.
can identify granulomas, but the diagnosis should not
be based on pathological findings alone.
A response to
corticosteroid therapy does not establish the
diagnosis of sarcoidosis.
the serum angiotensin-converting–enzyme level is an
insensitive and nonspecific diagnostic test and a poor
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.
symptoms such as fatigue may predominate.
sarcoidosis is much more common than reported
previously and may cause loss of ventricular function
and sudden death.
neurologic sarcoidosis may occur without apparent
disease activity in other organs.
radiographic patterns (stages 1, 2, and 3) do not
reflect the chronology of the disease.
with sarcoidosis do not require therapy.
been few well-controlled studies of the use of any
therapeutic agent in patients with sarcoidosis — be
skeptical of anecdotal reports.
pulmonary sarcoidosis is best guided by
sarcoidal skin lesions are usually chronic and require
FDG PET denotes 18F-fluorodeoxyglucose positron-emission
tomography, MRI magnetic resonance imaging, and CT
Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med.
2007 Nov 22;357(21):2153-65.
Created: Mar 04, 2008