The lungs are the most commonly affected organ in sarcoidosis. Ninety percent or more of people with sarcoidosis have lung involvement, whether they have symptoms or not.  

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SYMPTOMS

• dry coughing
• trouble breathing, wheezing, or pain with breathing
• chest pain, tightness, or discomfort
• coughing up blood, which is rare, especially in the early stages of sarcoidosis

Some of the lung problems caused sarcoidosis, (usually only in the most serious cases), can include:

• interstitial lung disease (also called pulmonary fibrosis), when inflammation causes scar tissue to form on the lungs, leading to reduced oxygen levels in the blood and shortness of breath
• fibrocystic disease, an advanced form of lung disease that causes scars that block airways
• pulmonary hypertension (also called pulmonary arterial hypertension), which is high blood pressure in the arteries of the lungs caused by scar tissue that narrows or blocks them. The hypertension makes the heart work harder to pump blood through the vessels, which can weaken the heart muscle and hinder its ability to deliver oxygen to the lungs
• bronchiectasis, which makes the airways in your lungs unable to clear out mucus. The mucus then builds up, creating an environment where bacteria will grow. Over time, the airways become inflamed, stretched out, and scarred, making it harder for the lungs to move air through
• aspergilloma, which is a clump of fungus that forms in healed lung scars and enlarged airways. It can cause bleeding in the lungs

DIAGNOSIS

If your doctor suspects sarcoidosis, he or she will probably order a chest x-ray to see if you have lung inflammation. Alternatively, the doctor might suspect you have sarcoidosis after looking at a chest x-ray that you had done for some other reason. Although more than 90% of people with sarcoidosis will have abnormal x-rays, many other diseases can cause abnormal x-rays, too, so a chest x-ray alone is not enough to diagnose sarcoidosis.  For more information on specific diagnostic tools for sarcoidosis, visit the Diagnosis page of this Web site.

Diagnostic Tests for Pulmonary Sarcoidosis:

Biopsies
Unless you have severe lung damage that makes a biopsy dangerous, or unless it seems fairly certain that you have the type of sarcoidosis that goes away on its own quickly and without treatment, your doctor will likely recommend a lung or lymph node biopsy to look for granulomas if there are abnormalities on your chest x-ray.

Imaging Technology
In addition to x-ray images, a number of sophisticated imaging tools are available today that can detect inflammation and tumors not only in the lungs but in other parts of the body, as well. Computed tomography (CT) scans and magnetic resonance imaging (MRI) are probably the most commonly available of these technologies.

Other Lung Tests
In addition to imaging scans and lung biopsies, your doctor might recommend several other lung tests and procedures to look for granulomas or to identify the extent of lung damage, including:

• lung function tests, which measure how well your lungs are working
• fiberoptic bronchoscopy, to look inside your lungs for scarring and inflammation in your airways
• bronchoalveolar lavage, which can determine the type of inflammatory cell present in your lungs

TREATMENT

Many people with sarcoidosis will not require any treatment at all.  Sarcoidosis is often mild and usually goes away on its own within several years without causing serious damage.  However, estimates suggest that in up to 30 percent of people, the disease lasts a long time or a lifetime. It can also worsen over time.  For more information on specific treatments for sarcoidosis, visit the Treatment page of this Web site.

The preceding information relating to pulmonary sarcoidosis is excerpted from the FSR publication 'Sarcoidosis and the Body', © 2007.  Click Here to order your free copy.