Sarcoidosis

Pulmonary sarcoidosis radiographic staging[56]Scadding JG. Prognosis of intrathoracic sarcoidosis in England: a review of 136 cases after five years' observation. Br Med J. 1961 Nov 4;2(5261):1165-72. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1970202/pdf/brmedj03022-0031.pdf http://www.ncbi.nlm.nih.gov/pubmed/14497750?tool=bestpractice.com

Stage 0: normal

Stage I: bilateral hilar lymphadenopathy

Stage II: bilateral hilar lymphadenopathy plus pulmonary infiltrates

Stage III: pulmonary infiltrates without hilar lymphadenopathy

Stage IV: extensive fibrosis with distortion.

Major diagnostic criteria[31]Crouser ED, Maier LA, Wilson KC, et al. Diagnosis and detection of sarcoidosis. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2020 Apr 15;201(8):e26-51. https://www.atsjournals.org/doi/10.1164/rccm.202002-0251ST http://www.ncbi.nlm.nih.gov/pubmed/32293205?tool=bestpractice.com

Diagnosis is not standardized, but is based on three main criteria:

• Clinical presentation

• Nonnecrotizing granulomatous inflammation in one or more tissue samples (not always required)

• Exclusion of other causes of granulomatous disease.

Diagnosis is never fully secure because there are no established objective measures to determine whether each criterion has been satisfied.