Stenosing non-caseating tuberculosis (sarcoidosis) of the bronchi.

CASE 1.-Case 1* is that of a man born in 1923. He was employed in toolrraking and light engineering, involving no dust hazard. In 1940 cervical lymph nodes, presumed tuberculous, were excised. In October, 1951, he developed cough, expectoration, and breathlessness on exertion. In February, 1952, a chest radiograph (Fig. 1) showed shadowing in the right middle lobe and some faint mottling in the upper zones of both lungs, with a rounded shadow at the right hilum suggestive of enlarged lymph nodes. The middle lobe shadow cleared in three months without treatment, but wheezy dyspnoea persisted, with increasing volumes of purulent, occasionally bloodstained sputum. In December, 1952, he had an acute febrile illness with right pleuritic pain. The radiograph showed shadowing in the lower zone of the right lung. He was treated with penicillin, but resolution of the shadows was slow. Bronchoscopy at this stage showed no abnormality, but bronchography showed slight narrowing of the middle lobe bronchus and of some of the basal segmental bronchi on the right side. By now dyspnoea was so severe that he was unable to continue his work as a toolmaker. In October, 1953, he had another febrile illness, associated with collapse-consolidation of the anterior and posterior segments of the right upper lobe. This again cleared slowly after penicillin treatment. Tomography suggested enlargement of the right hilar nodes. At this time his general condition was poor. There was soft stridor, both inspiratory and expiratory. Respiration was laboured with prolonged wheezy expiration, and an inspiratory rhonchus was persistently audible on the right side. No lymph nodes were palpable. Bronchography in January, 1954, revealed a remarkable appearance of multiple bronchial strictures (Figs.