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The diagnostic of sarcoidosis is done when clinical and radiological usual signs are present with nonnecrotizing granuloma and in the absence of any other granulomatous disease. However, if associated with usual manifestations of sarcoidosis and if published similar case reports are available, diagnostic is not excluded by atypical clinical or radiological facts. Chest thin-section hight-resolution computed tomographic scan is very useful to obvious typical findings when chest-X-ray looks unusual. In some cases, achievement of granuloma can be delayed if sarcoidosis does not require any drug. Besides, difficulties exist regarding alternative diagnosis, particularly tuberculosis for patients from endemic countries. Lastly, clinical course manifestations rise to know the discriminate between sarcoidosis, treatment side-effects and others sarcoidosis-associated diseases.

The radiographical and clinical expression of sarcoidosis is highly variable according to the initial presentation, the organs involved and the course of the disease. An abnormal chest radiography is noticed in 90% cases. The radiographic staging makes possible an estimation of both the length of sarcoidosis and the probability of recovery. Extrathoracic localizations can appear at a variable time in the natural history of sarcoidosis, these are related to a short- or longstanding form of the disease and are influenced by the epidemiological context. An accurate knowledge of the natural history allows enhance the security of diagnosis, to plan the survey and to better interpret clinical events during evolution.

Sarcoidosis is a multisystem disorder of unknown aetiology characterized by immune granuloma in involved tissue with predilection for lung and lymphoid system. The sarcoidosis aetiology remains unknown. It could result of genetic predisposition and exposure to specific enviromental factors. The chest X-ray is abnormal in 90% of cases with adenopathies and/or massive pulmonary infiltration with or without fibrosis. The different aspects are classified in 4 stages. The diagnosis is done when clinical and radiological usual signs are present with histological granuloma without caseum and in the absence of any other granulomatous disease. Most of the time, sarcoidosis spontaneously heals in 2 to 3 years. 10 to 30% of cases are chronic and often more severe. The disease could lastly generate a pulmonary fibrosis with a potential respiratory insufficiency, cor pulmonale, or aspergillus infection. Cardiac, neurologic, throat, kidney or ophthalmologic lesions or hypercalcemia may also be of bad prognosis. Sarcoidosis is lethal in 0.5 to 5% of cases. Mild disease does not need to be treated. Systemic corticosteroid for 12 months at least is the treatment for more severe diseases. Antimalarials drugs and immunomodulatory agents may be used if corticosteroids cannot be used or failed. TNFalpha recently proposed is currently evaluated.