CT scan of the chest showing lymphadenopathy (arrows) in the mediastinum due to<unk>  Diagnosis of<unk>  is a matter of exclusion, as there is no specific test for the condition. To exclude<unk>  in a case presenting with pulmonary symptoms might involve a chest radiograph, CT scan of chest, PET scan, CT-guided biopsy, mediastinoscopy, open lung biopsy, bronchoscopy with biopsy, endobronchial ultrasound, and endoscopic ultrasound with fine-needle aspiration of mediastinal lymph nodes (EBUS FNA). Tissue from biopsy of lymph nodes is subjected to both flow cytometry to rule out cancer and special stains (acid fast bacilli stain and Gömöri methenamine silver stain) to rule out microorganisms and fungi. Serum markers of<unk> , include: serum amyloid A, soluble interleukin-2 receptor, lysozyme, angiotensin converting enzyme, and the glycoprotein KL-6. Angiotensin-converting enzyme blood levels are used in the monitoring of<unk> . A bronchoalveolar lavage can show an elevated (of at least 3.5) CD4/CD8 T cell ratio, which is indicative (but not proof) of pulmonary<unk> . In at least one study the induced sputum ratio of CD4/CD8 and level of TNF was correlated to those in the lavage fluid. A<unk> -like lung disease called granulomatous–lymphocytic interstitial lung disease can be seen in patients with common variable immunodeficiency (CVID) and therefore serum antibody levels should be measured to exclude CVID. Differential diagnosis includes metastatic disease, lymphoma, septic emboli, rheumatoid nodules, granulomatosis with polyangiitis, varicella infection, tuberculosis, and atypical infections, such as Mycobacterium avium complex, cytomegalovirus, and cryptococcus.<unk>  is confused most commonly with neoplastic diseases, such as lymphoma, or with disorders characterized also by a mononuclear cell granulomatous inflammatory process, such as the mycobacterial and fungal disorders. Chest radiograph changes are divided into four stages: # bihilar lymphadenopathy # bihilar lymphadenopathy and reticulonodular infiltrates # bilateral pulmonary infiltrates # fibrocystic<unk>  typically with upward hilar retraction, cystic and bullous changes Although people with stage 1 radiographs tend to have the acute or subacute, reversible form of the disease, those with stages 2 and 3 often have the chronic, progressive disease; these patterns do not represent consecutive "stages" of<unk> . Thus, except for epidemiologic purposes, this categorization is mostly of historic interest. In<unk>  presenting in the Caucasian population, hilar adenopathy and erythema nodosum are the most common initial symptoms. In this population, a biopsy of the gastrocnemius muscle is a useful tool in correctly diagnosing the person. The presence of a noncaseating epithelioid granuloma in a gastrocnemius specimen is definitive evidence of<unk> , as other tuberculoid and fungal diseases extremely rarely present histologically in this muscle. Cardiac magnetic resonance imaging (CMR) is one modality for diagnosing cardiac<unk> . It has 78% specificity in diagnosing cardiac<unk> . Its T2-weighted imaging can detect acute inflammation. Meanwhile, late gadolinium contrast (LGE) can detect fibrosis or scar. Lesions at the subpericardium and midwall enhancement of basal septum or inferolateral wall is strongly suggestive of<unk> . MRI can also follow up on the treatment efficacy of corticosteroids and prognosis of cardiac<unk> . PET scan is able to quantify disease activity which cannot be performed by CMR. File:HilarAdenopathy.Hilar adenopathy especially on the person's left (AP CXR) File:HilarAdenopathyLt.Hilar adenopathy especially on the person's left (lateral CXR) File:HilarAdenopathyCCor.Hilar adenopathy especially on the person's left (coronal CT) File:HilarAdenopathyCT.Hilar adenopathy especially on the person's left (transverse CT) Classification<unk>  may be divided into the following types: * Annular<unk>  * Erythrodermic<unk>  * Ichthyosiform<unk>  * Hypopigmented<unk>  * Löfgren syndrome * Lupus pernio * Morpheaform<unk>  * Mucosal<unk>  * Neurosarcoidosis * Papular<unk> coid * Scar<unk> coid * Subcutaneous<unk>  * Systemic<unk>  * Ulcerative<unk>
Sarcoidosis
Cat-scratch disease
Melioidosis
Tuberculosis
Gamasoidosis
Sporotrichosis
Milk-alkali syndrome
Amyloidosis