[Clinical and paraclinical of mediastinal-pulmonary sarcoidosis]

Radiographic and clinical manifestation of mediastinal pulmonary sarcoidosis depend on a number of factors, particularly ethnic origin, and especially the type of chest radiographic change. Clinically, the physician takes into account the age of the patient, the frequent discordance between the absence or presence of only slight functional respiratory signs and discrete alterations of respiratory function on the one hand, and the severity of thoracic lesions on radiography, the presence of hilar and (or) mediastinal adenopathy and occasional extrathoracic localisations. Elevated serum levels of angiotensin converting enzyme, CD4+ T lymphocytosis in the broncho-alveolar lavage fluid and increased pulmonary GA-67 uptake reflect disease activity but are not prognostic. The key to diagnosis is histology. Such diagnosis requires demonstration of noncaseating tuberculoid granuloma, and exclusion of all other aetiologies capable of inducing such a histological lesion. Data obtained by clinical observation, radiography, scanning and functional respiratory and laboratory tests are not, in most cases, predictive of the course.