Because no specific diagnostic test exists, sarcoidosis is a diagnosis of exclusion. Evaluation of a patient for sarcoidosis may include1,12:
• Detailed history and physical: emphasis on lungs, skin, eyes, nervous system and heart
• Chest radiograph:
Stage 1: bilateral hilar with or without paratracheal adenopathy
Stage 2: adenopathy with pulmonary infiltrate
Stage 3: pulmonary infiltrates only Stage 4: pulmonary fibrosis
• Pulmonary function tests: restrictive pattern with decreased diffusing capacity (DLCO)
• Biopsy of affected tissue: demonstrates non-caseating granulomas
• Serum chemistry: elevated alkaline phosphatase and/or hypercalcaemia may be found, but these are not specific for sarcoidosis
• Angiotensin converting enzyme (ACE):
measurement is generally not a useful guide for diagnosis or therapeutic response
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