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Sarcoidosis is a systemic granulomatous condition of unknown origin. It is defined by histological features of epithelioid and giant-cell granuloma without caseous necrosis. Skin manifestations are observed in 25% of the cases of sarcoidosis, sometimes appearing as the inaugural symptom. Although these skin disorders are not life threatening, they do have a major functional and/or esthetic impact and may require specific therapy using aggressive treatments. Recent progress in immunology and molecular biology is helpful in understanding interactions between monocyte-macrophages and T lymphocytes and the cytokine pattern implicated in the granulomatous reaction. Research concerning the agent(s) causing the focus of the immune response on the TH1 pathway may be helpful in developing promising immunomodulation therapies. The very unpredictable course of the disease explains the difficulties encountered in assessing therapeutic efficacy and the small number of controlled trials. General corticosteroid therapy remains the mainstay treatment for severe skin disorders in sarcoidosis. APS and local corticoid therapy can be useful when systemic corticosteroids are not needed or to achieve a steroid-sparing effect. Indications for methotrexate and new compounds such as thalidomide or certain antibiotics with an immunomodulator effect remain to be evaluated.

Imaging plays an important role in identifying thoracic, abdominal and neurological localizations of sarcoidosis as well as ENT and bone localizations. It contributes to disease detection and is helpful for diagnostic, prognostic and therapeutic decision making and useful for therapeutic monitoring. The chest x-ray is particularly important in the initial work-up and to follow well-tolerated disease. Other investigations, depending on the localization, are helpful to follow the course of severe or chronic sarcoidosis.

Many atypical forms of sarcoidosis have been described. mediastinum-lung involvement, observed in 90% of the cases, may cause atypical manifestations: hemoptysis, chest pain, predominant pleural or proximal bronchial involvement. Diffuse "unpolished glass" images or air cavities may be observed on the chest x-ray. A rigorous diagnostic work-up is necessary for these atypical forms. Pathological confirmation is mandatory: non-caseous tuberculoid granuloma. A very wide range of extra-thoracic localizations have been described with variable clinical manifestations. In cases with no mediastinum-lung involvement, pathology data must be confronted with the notion of multiple organ dissemination to reach diagnosis.

Sarcoidosis is diffuse granulomatosis disease. The aetiology and pathogenesis are unknown. Many different localizations have been described together with immunological disturbances. Generally, the prognosis is favourable. Here we describe the pulmonary manifestations and their staging. Extra-pulmonary manifestations are then presented. Finally, the principle elements of the diagnosis and the treatment of sarcoidosis are discussed.

The authors have staged by CT 57 cases of sarcoidosis. In all cases CT has given superior semiologic pattern in comparison with plain-films which are the classical baseline references (Turiaf)...up to date. 30% of type I sarcoidosis are staged as type II by thin-section CT slices. This radio-clinic evaluation must be continued on months to find if this group is an homogeneous one in the prognostic meaning and if cortico-therapy is useful. The authors propose a systematic CT evaluation of sarcoidosis in 1987 and a CT actualization of the radiologic classification of the disease.