Advanced pulmonary sarcoidosis: the importance of HRCT, lung function and early detection of pulmonary hypertension

Advanced pulmonary sarcoidosis: the importance of HRCT, lung function and early detection of pulmonary hypertension

Publication date on this website: 7 October 2026.
Date of the original paper: 1 September 2026 (online 16 July 2026).

Introduction
A review in Current Opinion in Pulmonary Medicine describes newer approaches to recognizing, monitoring, and treating advanced pulmonary sarcoidosis. It focuses on distinguishing fibrosis from active inflammation and on the early recognition of complications.

Extended summary
Advanced pulmonary sarcoidosis encompasses late consequences of the disease, including pulmonary fibrosis with or without active inflammation and sarcoidosis-associated pulmonary hypertension. The authors emphasize phenotyping based on high-resolution computed tomography (HRCT), assessing the extent of fibrosis together with lung function tests, and earlier use of echocardiography when the clinical picture suggests possible pulmonary hypertension. FDG-PET/CT may provide additional information about the inflammatory burden, but it must be interpreted in the context of the other findings.

Treatment is gradually moving away from excessive and prolonged corticosteroid use toward steroid-sparing medicines that may reduce cumulative toxicity. In confirmed pulmonary hypertension, the choice of treatment depends on the mechanism and the overall assessment; vasodilator therapy may be considered in selected patients after confirmation and specialist evaluation.

What is new
The review links the HRCT phenotype, extent of fibrosis, lung function, echocardiography, and FDG-PET/CT in the monitoring of advanced disease. It particularly emphasizes that early assessment and a multidisciplinary approach may help identify patients at higher risk.

Why it matters to people with sarcoidosis and clinicians
For people with sarcoidosis, the text explains why more severe pulmonary disease cannot be monitored using only one parameter. For clinicians, it provides a practical framework for linking imaging, functional tests, and assessment of possible right-heart strain. Timely recognition of pulmonary hypertension is important because it can substantially affect prognosis and the choice of further evaluation.

Limitations of the evidence
This is a review article, not a new randomized clinical trial. Advanced pulmonary sarcoidosis includes different phenotypes, and evidence on the treatment of pulmonary hypertension often comes from smaller studies and specialized cohorts. FDG-PET/CT and echocardiography do not, on their own, provide a definitive diagnosis or determine treatment.

Conclusion
Advanced pulmonary sarcoidosis requires regular and multidisciplinary monitoring. Combining HRCT, lung function, cardiac assessment, and careful clinical evaluation may help recognize complications earlier and support a more rational choice of treatment.

Source and bibliographic details
Tadjkarimi J, Lynn E, Desai S, Kouranos V. Recent updates in advanced pulmonary sarcoidosis. Current Opinion in Pulmonary Medicine. 2026;32(5):491–499. Published 1 September 2026; online 16 July 2026. DOI: 10.1097/MCP.0000000000001295. PMID: 42471773.
Source: https://pubmed.ncbi.nlm.nih.gov/42471773/

Medical note
This text is for informational purposes and does not replace a medical examination, diagnosis, or individualized advice. Do not interpret scans independently, change treatment, or draw conclusions about pulmonary hypertension without medical evaluation.