The diagnosis of sarcoidosis

To review the diagnostic approach to sarcoidosis. There is no gold standard diagnostic test, procedure or algorithm for sarcoidosis. The diagnosis is based on a compatible clinical presentation, histologic findings of granulomatous inflammation, exclusion of alternative diseases, and evidence of systemic involvement. Occasionally, there may be exceptions to several of these requirements.

The diagnostic specificity of several specific clinical features are discussed. Typical histologic findings of sarcoidosis are described. Several diseases that may mimic sarcoidosis are reviewed.

The diagnosis of sarcoidosis usually involves weighing the clinical evidence for and against the diagnosis, coupled in most cases with histologic evidence of granulomatous inflammation. This approach requires knowledge of the varied presentations of the disease and other alternative conditions as well as histologic examination of an affected tissue in most instances.