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., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
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].