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