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How is sarcoidosis diagnosed?
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Dr Samantha Herath
Respiratory & Sleep Medicine Physician
Dr Samantha Herath completed her Respiratory and Sleep Medicine training in New Zealand, Australia and Canada. She has extensive post-fellowship, sub-speciality training in Sleep Medicine … View Profile
Sarcoidosis is a disease for which we do not know the exact cause. Sarcoidosis most commonly affects the lungs or the lymph glands in the lungs ( up to 90%). Sarcoidosis also affects the skin causing a purple colored rash, the eyes causing eye irritation or red eyes and the heart causing abnormalities in the heart rhythm. It can sometimes affect the brain as well.
When the lungs are involved patients can present with a dry cough, shortness of breath or chest pain. However, the majority of patients with sarcoidosis do not have any symptoms and the diagnosis was made when a chest X-ray or a CT scan was performed for another reason.
Sarcoidosis is a non-cancerous inflammatory condition that causes the normal body immune cells to form " granulomas'. These granulomas cannot be seen via the naked eye and can only be seen in a biopsy specimen of the affected organs when examined under a microscope. Many other conditions can also cause granulomas. One common condition that can mimic sarcoidosis and also cause granulomas is tuberculosis. The type of granuloma found in Tuberculosis has "necrosis" or dead tissue in it where as granulomas due to sarcoidosis usually does not have necrosis.
In sarcoidosis the lymph glands in the centre of the chest becomes enlarged. Enlargement of the lymph nodes can also occur in disease like lymphoma which is a type of cancer involving the lymph glands.
Therefore, diagnosis of sarcoidosis should be made by a specialised Respiratory Physician as the vast majority of patient's with sarcoidosis have lung involvement. Before diagnosing a patient with sarcoidosos it is imporatnt to exclude other causes that can mimic sarcoidosis like tuberculosis and lymphoma
The diagnosis is made in combination of
1. Clinical symptoms ( shortness of breath, cough, chest pain or asymptomatic), together with 2. findings in a high-resolution CT scan of the
2. Findings in a high-resolution CT scan of the chest ( demonstrating enlarged lymph nodes in the center of the chest, small nodules appearing in the lung tissue especially along the windpipes, with abnormalities usually involving the upper lobes of the lungs.
3. Biopsy of the enlarged lymph nodes in the chest using EBUS: These lymph nodes are hidden inbetwen the large blood vessels and the heart. Therefore, a specialised ultra sound guided bronchoscopic biopsy called Linear EBUS is required to obtain tissue to find out if there are "non necroting granulomas" as explained above. These biopsy samples are sent for a test called "flow cytometry" to exclude lymphoma and also need to be sent for "culture" which looks to see if the bacteria called micobacterium tuberculosis grows in this.
It is an added advantage if your Respiratory Physician is also capable of performing this EBUS procedure.
4. Breathing tests: That may demonstrate a reduced lung volume and/or reduction in the ability to transfer oxygen to the bloodstream, even when the patient is not very symptomatic
5. Blood tests: There is a blood test called serum ACE level (Angiotensin Converting Enzyme ). This level is elevated in sarcoidosis mostly during a flare-up of the disease.
in addition to the above:
6. With skin involvement: A skin biopsy would be required
7. With Cardiac involvement: An ECG and echocardiogram may be required
8. With eye involvement: An ophthalmology review as well as a corneal biopsy may be required
9.Rarely with brain invlovement: an MRI scan and neurology opinion is required.
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