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Screening and diagnosis

Sarcoidosis produces few signs and symptoms in its early stages, and when they do occur, they often resemble those of other illnesses. For that reason, your doctor will diagnose sarcoidosis only after ruling out diseases with similar features such as lymph cancer (lymphoma), tuberculosis, rheumatoid arthritis, rheumatic fever and fungal infections.

Even then, sarcoidosis can be missed. In the majority of cases, undiagnosed sarcoidosis disappears on its own, but a few people go on to develop more severe signs and symptoms — usually over a period of years.

No single noninvasive test can positively identify sarcoidosis, but initially, your doctor is likely to order a chest X-ray. Depending on the results, you may then have one or more of the following:

  • Pulmonary function tests (PFTs). These noninvasive tests measure how much air your lungs can hold and the flow of air in and out of your lungs. They can also measure the amount of gases exchanged across the membrane between your lung wall and capillary membrane. During the tests, you're usually asked to blow into a simple instrument called a spirometer. You're most likely to have pulmonary function tests if you're short of breath or a chest X-ray shows changes in your lungs.

  • Blood tests. These are used to check your liver function and the amount of calcium in your blood. For reasons that aren't clear, some people with sarcoidosis have higher than normal blood-calcium levels. Blood tests can also measure a substance called angiotensin-converting enzyme (ACE). Some — but not all — people with sarcoidosis have high levels of ACE, which is produced by the cells that make up granulomas. High ACE levels can also result from other illnesses.

  • Bronchoscopy. In this procedure, your doctor uses a thin, flexible tube (bronchoscope) to examine the inside of your air passages and to take a small tissue sample (biopsy) for laboratory analysis. The sample can tell your doctor whether noncaseating granulomas — microscopic changes in tissue that occur in sarcoidosis — have formed in your lungs.

  • Biopsy of your skin, lymph nodes or the outer membrane (conjunctiva) of your eye. If parts of your body other than your lungs appear to be affected, your doctor is likely to arrange for a specialist to take tissue samples from these areas. The samples are then examined for noncaseating granulomas. Still, because these granulomas can result from a number of conditions, their presence alone can't confirm a diagnosis of sarcoidosis.

  • Mediastinoscopy. In this procedure, your surgeon removes a sample of lymph nodes from the space between your lungs (mediastinum) using one or more small incisions. If you have sarcoidosis, the disease is likely to have spread to the lymph nodes in your chest cavity even if the nodes aren't enlarged on a chest X-ray or CT scan. Risks of the procedure include bleeding, temporary hoarseness and reaction to the anesthetic.

  • Slit-lamp examination. In this exam, your doctor uses a high-intensity lamp to examine the inside of your eyes for damage from sarcoidosis.


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