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Investigations

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Recommended initial evaluation of sarcoidosis includes:

  • a detailed history from the patient - inquire about
    • any extrapulmonary symptoms which may relate to skin, eyes, and joints involvement
    • occupational and environmental dust exposure - may indicate hypersensitive pneumonitis
    • family history of sarcoidosis (1)
  • physical examination
    • should be carried out according to the symptoms
    • identify any possible biopsy sites e.g. - lymphadenopathy, skin lesions, old scars, and tattoos (1)
  • chest radiology
    • used for staging which is of prognostic value (1)
    • bilateral hilar lymphadenopathy (BHL) is seen in close to three quarters of patients (2)
  • lung function tests - may show reduced transfer factor and a restrictive ventilatory defect
  • blood tests
    • full blood count
    • liver function test
    • serum (and urinary) electrolytes and calcium - hypercalcaemia and hypercalciuria are common
    • serum angiotensin converting enzyme (ACE) - may be raised in acute sarcoidosis, however, the low specificity of the test renders it useful only for monitoring the severity of disease (1)
  • ECG - findings suggestive of latent cardiac sarcoidosis are arrhythmias and conduction delay (3)
  • tuberculin tests up to 1 in 100 are negative in 75% of patients
  • ophthalmology review - slit lamp examination to recognize symptomatic and potentially sight threatening uveitis (1)
  • high resolution CT
    • is a standard investigation in hospital setting and can be used to assess the involvement and to identify abnormal nodes for biopsy (1).
    • may reveal the presence of parenchymal disease, not revealed by a chest radiograph
  • tissue biopsy:
    • samples: lymph nodes, bronchial, transbronchial, liver, skin, eyelids and muscle
    • transbronchial samples are histologically positive in 90% of patients with pulmonary sarcoidosis
  • Kviem test:
    • positive in 80% of cases of acute sarcoidosis
    • not used now because of risk of infection
  • sputum should be examined microscopically and cultured to exclude the presence of Mycobacterium tuberculosis.

Reference:


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