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Sarcoidosis vs. Idiopathic Pulmonary Fibrosis: A Clinical Evaluation Guide for Progressive Dyspnea and Pulmonary Function Tests

A middle-aged Hispanic physician in a white coat and stethoscope carefully examines a chest X-ray in a medical consultation room. The X-ray reveals clear pulmonary structures with signs of sarcoidosis and idiopathic pulmonary fibrosis. On the desk, there are medical charts and a laptop displaying a digital image of lungs. The atmosphere is professional and focused, highlighting the importance of pulmonary function tests in diagnosing progressive dyspnea and granulomas.

Sarcoidosis and idiopathic pulmonary fibrosis (IPF) are two interstitial lung diseases that, while sharing some clinical features, present significant differences in their etiology, pathogenesis, and clinical management. Both conditions can lead to progressive dyspnea and deterioration of pulmonary function, but they require distinct diagnostic and therapeutic approaches. In this article, we will explore the key differences between these two diseases and provide a guide for their evaluation in clinical practice.

Clinical and Diagnostic Evaluation

Sarcoidosis is a multisystem inflammatory disease of unknown cause, characterized by the formation of granulomas in the affected organs, primarily in the lungs. Patients may present with cough, dyspnea, chest pain, and pronounced fatigue. The diagnosis is complex due to variability in clinical presentation and the lack of pathognomonic markers. Pulmonary function tests and imaging, such as high-resolution computed tomography, are essential tools for assessing the extent of the disease and the risk of developing fibrosis [1].

On the other hand, idiopathic pulmonary fibrosis is a form of chronic fibrosing interstitial pneumonia of unknown cause, characterized by a usual interstitial pneumonia pattern on computed tomography. IPF is associated with a poor prognosis and rapid progression to respiratory failure. Treatment with antifibrotics such as nintedanib has been shown to reduce disease progression, although it comes with significant gastrointestinal side effects [2].

Pulmonary hypertension is a common complication in both diseases, exacerbating dyspnea and worsening prognosis. Evaluation through echocardiography and right heart catheterization is crucial to differentiate between primary pulmonary hypertension and that secondary to lung disease [3].

Conclusions

Differentiating between sarcodiosis and idiopathic pulmonary fibrosis is fundamental for the appropriate management of patients. While sarcoidosis may require immunosuppressive treatment, IPF benefits from antifibrotic therapies. Clinical evaluation should include a thorough review of symptoms, pulmonary function tests, and imaging studies to guide diagnosis and treatment. Multidisciplinary collaboration is essential to optimize outcomes in these complex patients.

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Created 6/1/2025