Pulmonary sarcoidosis represents one of the most prevalent and clinically significant manifestations of this complex disease. This chapter delves into the intricate details of how sarcoidosis affects the lungs, exploring the spectrum of pulmonary manifestations from asymptomatic radiographic findings to progressive fibrosis and respiratory compromise. Central to this discussion are the patterns of granuloma formation within lung tissue, their impact on pulmonary function, and the diagnostic challenges they pose. By unraveling the nuances of pulmonary sarcoidosis—from its radiological appearance to histopathological correlates and clinical outcomes—we aim to provide a comprehensive overview that aids clinicians in optimizing patient management and improving prognostic outcomes.