Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
No single test can be relied on for a correct diagnosis
of sarcoidosis. X-rays and blood tests are usually the first procedures the
doctor will order. Pulmonary function tests often provide clues to
diagnosis. Other tests may also be used, some more often than others.
Many of the tests that the doctor calls on to help diagnose
sarcoidosis can also help the doctor follow the progress of the disease and
determine whether the sarcoidosis is getting better or worse.
Chest x-ray
The chest x-ray is often helpful to give the doctor a
picture of the lungs, heart, as well as the surrounding tissues containing lymph
nodes (where infection-fighting white blood cells form) and give the first
indication of sarcoidosis. For example, a swelling of the lymph
glands between the two lungs can show up on an x-ray. An x-ray can
also show which areas of the lung are affected.
Pulmonary function test
By performing a variety of tests called pulmonary function tests (PFT), the doctor can find out how well the lungs are doing their job
of expanding and exchanging oxygen and carbon dioxide with the
blood. The lungs of sarcoidosis patients cannot handle these tasks as well
as they should; this is because granulomas and fibrosis of lung tissue
decrease
lung capacity and disturb the normal flow of gases between the
lungs and
the blood. One PFT procedure calls for the patient to breathe
into a
machine, called a spirometer. It is a mechanical device that
records
changes in the lung size as air is inhaled and exhaled, as well
as the
time it takes the patient to do this.
Blood test
Blood analyses can evaluate the number and types of blood
cells in the body and how well the cells are functioning. They can also measure
the levels of various blood proteins known to be involved in immunological
activities, and they can show increases in serum calcium levels
and
abnormal liver function that often accompany sarcoidosis.
Blood tests can measure a blood substance called angiotensin
converting enzyme (ACE). Because the cells that make up
granulomas secrete
large amounts of ACE, the enzyme levels are often high in
patients with
sarcoidosis. ACE levels, however, are not always high in
sarcoidosis
patients, and increased ACE levels can also occur in other
illnesses.
Bronchoalveolar lavage
This uses an instrument called a bronchoscope—a long,
narrow tube with a
light at the end—to wash out, or lavage, cells and other
materials from
inside the lungs. This wash fluid is then examined for the
amount of
various cells and other substances that reflect inflammation
and immune
activity in the lungs. A high number of white blood cells in
this fluid
usually indicate an inflammation in the lungs.
Biopsy
Microscopic examination of specimens of lung tissue obtained
with a
bronchoscope, or of specimens of other tissues, can tell a
doctor where
granulomas have formed in the body and can provide the ultimate diagnosis.
Gallium scanning
In this procedure, the doctor injects the radioactive chemical
element gallium-67 into the patient's vein. The gallium collects at places in
the body affected by sarcoidosis and other inflammatory conditions. Two days
after the injection, the body is scanned for radioactivity. Increases in gallium
uptake at any site in the body indicate that inflammatory activity has developed
at the site and give an idea of which tissue, and how much tissue, has been
affected. However, since any type of inflammation causes gallium uptake, a
positive gallium scan does not
necessarily mean
that the patient has sarcoidosis.
Kveim test
This test involves injecting a standardized preparation of
sarcoid
tissue material into the skin. On the one hand, a unique lump
formed at
the point of injection is considered positive for sarcoidosis.
On the
other hand, the test result is not always positive even if the
patient has
sarcoidosis.
The Kveim test is not used often in the United States
because no test material has been approved for sale by the U.S. Food and Drug
Administration. However, a few hospitals and clinics may have
some
standardized test preparation prepared privately for their own
use.
Slit-lamp examination
An instrument called a slit lamp, which permits examination of
the
inside of the eye, can be used to detect silent damage from
sarcoidosis.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Low testosterone can affect both men and women. Causes of low testosterone in males include undescended testicles and injury to the scrotum. Low testosterone in females includes ovary conditions. Treatment for low testosterone in men includes testosterone replacement therapy. Currently there is no FDA approved testosterone treatment for women.
Carpal tunnel syndrome is a condition in which irritation of the wrist's median nerve causes tingling and numbness of the thumb, index, and the middle fingers. This condition is known as tarsal tunnel syndrome in the ankles and feet. Treatment of carpal tunnel syndrome depends on the severity of the symptoms and the nature of any disease that might be causing the symptoms.
Pulmonary fibrosis is scarring throughout the lungs. Pulmonary fibrosis can be caused by many conditions including chronic inflammatory processes, infections, environmental agents, exposure to ionizing radiation, chronic conditions, and certain medications. Symptoms include shortness of breath, coughing, and diminished exercise tolerance. Treatment options are dependent on the type of pulmonary fibrosis; lung transplant and/or medications are optons.
Eye floaters are deposits or condensation that forms in the eye's vitreous humor. These deposits cast shadows on the retina, and as the eye moves, the deposits shift position, making it appear as though the shadows are moving or floating.
Pulmonary hypertension is an abnormal elevation of the pressure in the pulmonary circulation caused by the constriction of the blood vessels that supply blood to the lungs. Shortness of breath and dizziness are symptoms of pulmonary hypertension. Treatment involves diuretics, blood thinners, calcium channel blockers, and using supplemental oxygen to increase blood oxygen levels.
Erythema nodosum is a skin inflammation that results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees. Erythema nodosum can resolve on its own in 3 to 6 weeks, leaving a bruised area. Treatments include anti-inflammatory medications and cortisone by mouth or injection.
Pericarditis is the inflammation of the pericardial sac that surrounds the heart. The causes of pericarditis include injury from heart attack, heart surgery, trauma; viral or fungal infection, HIV, tumors, mixed connective tissue disease, metabolic disease, medication reactions, or idiopathic. Treatment for pericarditis is generally medication, however, sometimes surgery is necessary.
Interstitial lung disease, is a term to describe a certain lung condition. Causes of interstitial lung disease include lung infection, exposure to toxins in the environment (asbestos for example), medications (chemotherapy), radiation therapy, and chronic autoimmune disorders. Common symptoms of interstitial lung disease include a dry cough and shortness of breath. Diagnosis and treatment depend upon the cause of the condition.
Optic neuritis is inflammation of the optic nerve, the structure that connects the eye to the brain. The precise cause of optic neuritis is unknown, but it is thought to be a type of autoimmune disorder. Optic neuritis most commonly develops due to an autoimmune disorder that may be triggered by a viral infection.
Myocarditis is an inflammation of the heart muscle and can be caused by a variety of infections, conditions, and viruses. Symptoms of myocarditis include chest pain, shortness of breath, fatigue, and fluid accumulation in the lungs. Treatment mainly involves preventing heart failure with medication and diet, as well as monitoring for heart rhythm abnormalities.
Sudden cardiac arrest is an unexpected, sudden death caused by sudden cardiac arrest (loss of heart function). Causes and risk factors of sudden cardiac arrest include (not inclusive): abnormal heart rhythms (arrhythmias), previous heart attack, coronary artery disease, smoking, high cholesterol, Wolff-Parkinson-White Syndrome, ventricular tachycardia or ventricular fibrillation after a heart attack, congenital heart defects, history of fainting, and heart failure, obesity, diabetes, and drug abuse. Treatment of sudden cardiac arrest is an emergency, and action must be taken immediately.
Brain lesions (lesions on the brain) are caused by trauma, inflammation, autoimmune diseases, cancers, other diseases, stroke, bleeding, pituitary adenomas, and cerebral palsy. Symptoms of brain lesions include headache, nausea, fever, neck pain and stiffness, affected vision and speech, weakness or paralysis to one side of the body. Diagnosis of brain lesions is generally with imaging studies like CT or MRI scans. Treatment and prognosis of brain lesions depends on the cause of the lesion.
Iritis is inflammation of the iris, the colored portion of the eye. Symptoms include a red, painful eye, blurry vision, and light sensitivity. Treatment usually involves cortisone eyedrops.
Superior vena cava syndrome is compression of the superior vena cava vein located in the upper chest. Causes of superior vena cava include lung cancer, lymphoma, other cancers in the chest, blood clots in the superior vena cava, or infection. Symptoms of the syndrome include shortness of breath. Superior vena cava syndrome is diagnosed by ultrasound, chest x-ray, CT scan, and in some cases biopsy. Treatment depends upon the cause of the syndrome.
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