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      CT Findings in Pulmonary and Abdominal Sarcoidosis. Implications for Diagnosis and Classification

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          Abstract

          Sarcoidosis is a granulomatous disorder of unknown etiology characterized by noncaseating granulomas virtually in every organ and tissue. This finding represents the most important diagnostic clue to reach a correct definition of sarcoidosis, although the biopsy is invasive and has several risk procedures. Several efforts are made to suspect the diagnosis of sarcoidosis by combining noninvasive elements, in particular from imaging, though these findings are often nonspecific and reflect the wide multifactorial pathogenesis. Every effort should be made to obtain a detailed radiological picture that, if associated with a suggestive clinical picture, could avoid the need of biopsy in some specific cases. In this narrative review, we aim to describe main computed tomography (CT) features of pulmonary and abdominal sarcoidosis, by reporting strengths and limits of this technique, in particular for the identification of extrapulmonary, isolated disease.

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          Most cited references72

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          Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999.

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            Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline

            Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure. Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability. Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality. Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.
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              An official American Thoracic Society clinical practice guideline: the clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease.

              The clinical utility of bronchoalveolar lavage fluid (BAL) cell analysis for the diagnosis and management of patients with interstitial lung disease (ILD) has been a subject of debate and controversy. The American Thoracic Society (ATS) sponsored a committee of international experts to examine all relevant literature on BAL in ILD and provide recommendations concerning the use of BAL in the diagnosis and management of patients with suspected ILD. To provide recommendations for (1) the performance and processing of BAL and (2) the interpretation of BAL nucleated immune cell patterns and other BAL characteristics in patients with suspected ILD. A pragmatic systematic review was performed to identify unique citations related to BAL in patients with ILD that were published between 1970 and 2006. The search was updated during the guideline development process to include published literature through March 2011. This is the evidence upon which the committee's conclusions and recommendations are based. Recommendations for the performance and processing of BAL, as well as the interpretation of BAL findings, were formulated by the committee. When used in conjunction with comprehensive clinical information and adequate thoracic imaging such as high-resolution computed tomography of the thorax, BAL cell patterns and other characteristics frequently provide useful information for the diagnostic evaluation of patients with suspected ILD.
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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                20 September 2020
                September 2020
                : 9
                : 9
                : 3028
                Affiliations
                [1 ]Geriatrics Clinic, “G. Bernabeo” Hospital, Contrada S. Liberata, 66026 Ortona (CH), Italy
                [2 ]Internal Medicine Unit, University Hospital of Salerno, 84131 Salerno, Italy; iginiodonatiello@ 123456gmail.com
                [3 ]Internal Medicine Unit, Ospedale del Mare, 80145 Napoli, Italy; gabry.cop@ 123456libero.it
                [4 ]Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, “G.d’Annunzio” University, 66100 Chieti, Italy; fabrizio.ricci@ 123456unich.it
                [5 ]Imaging Department, Hospital of Pescara, 65123 Pescara, Italy; maccaronemarica@ 123456hotmail.com
                [6 ]Internal Medicine Unit, Marcianise Hospital, 81025 Caserta, Italy; tiziana.ciarambino@ 123456gmail.com
                [7 ]Medical Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio”, University of Chieti, 66100 Chieti, Italy; fcipollone@ 123456unich.it
                [8 ]Geriatrics Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, 66100 Chieti, Italy; mag@ 123456unich.it
                Author notes
                [* ]Correspondence: claudio.tana@ 123456yahoo.it ; Tel./Fax: +39-085-9172287
                Article
                jcm-09-03028
                10.3390/jcm9093028
                7565100
                32962242
                644d7521-fef0-461f-9ac4-ad654d138920
                © 2020 by the authors.

                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 ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 11 August 2020
                : 18 September 2020
                Categories
                Review

                sarcoidosis,computed tomography,imaging,biopsy,lungs,liver,spleen
                sarcoidosis, computed tomography, imaging, biopsy, lungs, liver, spleen

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