Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

1320 Sarcoidosis

■Basic Urine Tests

➣24-h urine calcium indicated when hypercalcemia present

Specific Diagnostic Tests

■ACE level, pulmonary function tests, spirometry & DLCO, ECG, rou-

tine ophthalmologic exam, tuberculin skin test

■Kveim test used rarely and only in selected centers

Imaging

■PA CXR useful for prognostic staging:

➣Stage 0: normal CXR

➣Stage I: bilateral hilar lymphadenopathy (BHL)

➣Stage II: BHL plus pulmonary infiltrates

➣Stage III: pulmonary infiltrates (without BHL)

➣Stage IV: pulmonary fibrosis

■High-resolution chest CT: helpful when parenchyma appears nor-

mal on CXR

Biopsy

■A biopsy is required for definitive Dx in most cases

■Choose proper site (lung, lymph node, skin, lip, granulomatous scar;

E nodosum biopsy does not show granulomas)

■If no easily accessible biopsy site, transbronchial biopsy proce-

dure of choice (overall diagnostic yield 85%); other options: medi-

astinoscopy, VATS, open-lung biopsy

differential diagnosis

■Conditions to exclude:

➣Infections: TB, mycobacteriosis, cryptococcosis, histoplasmo-

sis, coccidiodomycosis, blastomycosis, aspergillosis, P. carinii,

mycoplasma

➣Occupational & environmental: hypersensitivity pneumonitis,

pneumoconiosis (beryllium, titanium, aluminum), drug reac-

tions, aspiration of foreign materials

➣Noninfectious: Wegener’s granulomatosis, chronic interstitial

pneumonia (LIP), necrotizing sarcoid granulomatosis, sarcoid

reaction in lymph node to carcinoma

management

What to Do First

■Establish baseline studies