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Establishing a Diagnosis of Pulmonary Sarcoidosis

Pulmonary sarcoidosis is the most prevalent manifestation of sarcoidosis and the commonest diagnosis in clinics for ILD. Due to the lack of a simple and reliable test, making the diagnosis is often challenging. There are three criteria that must always be considered: (1) compatible clinical presenta...

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Autor principal: Grutters, Jan C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10650830/
https://www.ncbi.nlm.nih.gov/pubmed/37959363
http://dx.doi.org/10.3390/jcm12216898
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author Grutters, Jan C.
author_facet Grutters, Jan C.
author_sort Grutters, Jan C.
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description Pulmonary sarcoidosis is the most prevalent manifestation of sarcoidosis and the commonest diagnosis in clinics for ILD. Due to the lack of a simple and reliable test, making the diagnosis is often challenging. There are three criteria that must always be considered: (1) compatible clinical presentation; (2) evidence of granuloma formation (usually non-caseating); and (3) exclusion of alternative causes of granulomatous disease. There are various tools available for diagnosis, amongst which serum biomarkers like sACE and sIL-2R, HRCT, BAL, EBUS/EUS and sometimes bronchoscopic or surgical lung biopsy are most contributive. However, the degree of invasiveness of the applied test and associated risk to the patient must be weighed against management consequences. In specific situations (e.g., presentation as Löfgren’s syndrome) or when there is high suspicion based on HRCT in the context of supportive clinical findings, it might be justifiable to decide on a “working diagnosis of sarcoidosis” and to refrain from further invasive procedures for the patient. This should, however, preferably be agreed upon after discussion in an experienced multidisciplinary team and requires close follow-up of the patient. In general, it is advisable to always maintain a healthy dose of skepticism when making the diagnosis of sarcoidosis, especially when the clinical course of disease gives rise to this.
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spelling pubmed-106508302023-11-02 Establishing a Diagnosis of Pulmonary Sarcoidosis Grutters, Jan C. J Clin Med Article Pulmonary sarcoidosis is the most prevalent manifestation of sarcoidosis and the commonest diagnosis in clinics for ILD. Due to the lack of a simple and reliable test, making the diagnosis is often challenging. There are three criteria that must always be considered: (1) compatible clinical presentation; (2) evidence of granuloma formation (usually non-caseating); and (3) exclusion of alternative causes of granulomatous disease. There are various tools available for diagnosis, amongst which serum biomarkers like sACE and sIL-2R, HRCT, BAL, EBUS/EUS and sometimes bronchoscopic or surgical lung biopsy are most contributive. However, the degree of invasiveness of the applied test and associated risk to the patient must be weighed against management consequences. In specific situations (e.g., presentation as Löfgren’s syndrome) or when there is high suspicion based on HRCT in the context of supportive clinical findings, it might be justifiable to decide on a “working diagnosis of sarcoidosis” and to refrain from further invasive procedures for the patient. This should, however, preferably be agreed upon after discussion in an experienced multidisciplinary team and requires close follow-up of the patient. In general, it is advisable to always maintain a healthy dose of skepticism when making the diagnosis of sarcoidosis, especially when the clinical course of disease gives rise to this. MDPI 2023-11-02 /pmc/articles/PMC10650830/ /pubmed/37959363 http://dx.doi.org/10.3390/jcm12216898 Text en © 2023 by the author. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Grutters, Jan C.
Establishing a Diagnosis of Pulmonary Sarcoidosis
title Establishing a Diagnosis of Pulmonary Sarcoidosis
title_full Establishing a Diagnosis of Pulmonary Sarcoidosis
title_fullStr Establishing a Diagnosis of Pulmonary Sarcoidosis
title_full_unstemmed Establishing a Diagnosis of Pulmonary Sarcoidosis
title_short Establishing a Diagnosis of Pulmonary Sarcoidosis
title_sort establishing a diagnosis of pulmonary sarcoidosis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10650830/
https://www.ncbi.nlm.nih.gov/pubmed/37959363
http://dx.doi.org/10.3390/jcm12216898
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