PULMONARY SARCOIDOSIS-INVESTIGATION
SUMMARY
IMAGING
1. CXR findings - bilateral hilar and/or mediastinal adenopathy +/- reticulonodular or alveolar infiltrates.
2. Radiographic staging of sarcoidosis: hilar adenopathy disappears as disease progresses.
PULMONARY FUNCTION TESTING
3. PFTs may either be normal or show restrictive +/- obstructive mechanics.
BLOOD INVESTIGATIONS
4. Serum ACE level is non-specific, but useful for monitoring progression of disease, new elevation indicates reactivation of disease.
5. Hypercalcemia, hypercalciuria, and hypergammaglobulinemia are common.
HISTOLOGY
6. Positive BAL shows lymphocytosis with helper/suppressor ratio of > 4:1.
7. Gold standard - bronchial wall biopsy shows non-caseating granulomas.
Reference(s)
Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].