Pulmonary Sarcoidosis: Diagnosis and Differential Diagnosis
Abstract
1. Introduction
2. Epidemiology and Definition
3. Clinical Features
4. Pulmonary Function Tests
5. Imaging
5.1. Chest Radiography
5.2. Computed Tomography (CT Scan)
5.3. Positron Emission Tomography (FDG PET/CT)
6. Confirmation of the Diagnosis
6.1. Fiberoptic Bronchoscopy
6.2. Bronchoalveolar Lavage
6.3. EBUS-TBNA
6.4. Transbronchial Lung Biopsy (TBLB)
6.5. Mediastinoscopy
6.6. Serological Biomarkers
7. Differential Diagnosis
7.1. Tuberculosis and Other Infectious Diseases
7.2. Occupational and Environmental Exposure: Chronic Beryllium Disease and Silicosis
7.3. Lymphoma, Cancer and Drug: The Sarcoid-like Reaction
7.4. Common Variable Immunodeficiency
7.5. Autoimmune Disorders
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Sensitivity | Specificity | Diagnostic Yield | References | |
---|---|---|---|---|
EBB | 46.2% | 85.7% | 30–70% | [39] |
TBLB | 37% | 100% | 50–75% | [52,60] |
EBUS/TBNA | 83–93% | 100% | 77–84% | [48,61] |
Mediastinoscopy | 100% | 100% | 82–100% | [58] |
BAL (CD4/CD8 ≥ 3.5) | 53–59% | 93–96% | 56% | [41,62] |
Sarcoidosis | Tuberculosis | CBD and Silicosis | Sarcoid-like Reactions (SLRs) | |
---|---|---|---|---|
Clinical presentation | Often asymptomatic May be an occasional diagnosis Dry cough, dyspnea Weight loss Fever | Weight loss Cough Purulent sputum Hemoptysis Fever | Dry cough and dyspnea | Often Asymptomatic |
Exposure history | Undefined | Recent travel to endemic countries, contact with TB patient | History of work/environment exposure to beryllium or silica | Drugs, malignancy or medical device implantation |
Radiological findings or localizations | Bilateral and symmetrical hilar lymphadenopathy Perilymphatic and peribronchovascular nodules Cavitation (rare) | Hilar lymphadenopathy (often asymmetrical) Cavitation (frequent) Randomly distributed nodules | Bilateral hilar lymphadenopathy (CBD); lymph nodes may have an egg-shell appearance (silicosis) | It depends on the underlying cause (i.e., lymph nodes near solid tumors) |
Laboratory | Hypercalcemia and hypercalciuria Elevated serum levels of ACE Elevated levels of sIL-2R Peripheral lymphopenia Mantoux test: anergic | Mantoux test: positive IGRA: positive ACE levels may be elevated | Mantoux test: negative ACE levels may be elevated | It depends on the underlying cause ACE may occasionally be elevated Mantoux test: negative |
Histopathology | Nonnecrotizing granulomas | Necrotizing granulomas | Nonnecrotizing granulomas Sclerotic nodules Silica particles | Indistinguishable from sarcoid granulomas |
Bronchoscopy and BALF | Lymphocytosis CD4+/CD8+ ratio generally > 3.5 | Culture positive for mycobacterium tuberculosis | Lymphocytosis Positive BeLPT (CBD) | Variable based on the underlying cause |
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Bernardinello, N.; Petrarulo, S.; Balestro, E.; Cocconcelli, E.; Veltkamp, M.; Spagnolo, P. Pulmonary Sarcoidosis: Diagnosis and Differential Diagnosis. Diagnostics 2021, 11, 1558. https://doi.org/10.3390/diagnostics11091558
Bernardinello N, Petrarulo S, Balestro E, Cocconcelli E, Veltkamp M, Spagnolo P. Pulmonary Sarcoidosis: Diagnosis and Differential Diagnosis. Diagnostics. 2021; 11(9):1558. https://doi.org/10.3390/diagnostics11091558
Chicago/Turabian StyleBernardinello, Nicol, Simone Petrarulo, Elisabetta Balestro, Elisabetta Cocconcelli, Marcel Veltkamp, and Paolo Spagnolo. 2021. "Pulmonary Sarcoidosis: Diagnosis and Differential Diagnosis" Diagnostics 11, no. 9: 1558. https://doi.org/10.3390/diagnostics11091558
APA StyleBernardinello, N., Petrarulo, S., Balestro, E., Cocconcelli, E., Veltkamp, M., & Spagnolo, P. (2021). Pulmonary Sarcoidosis: Diagnosis and Differential Diagnosis. Diagnostics, 11(9), 1558. https://doi.org/10.3390/diagnostics11091558