Bilateral endobronchial metastases due to a chondroblastic osteosarcoma.

The first descriptions of disease currently recognized as sarcoidosis were documented at the end of the 19th century and concerned skin eruptions (1). Since that time, it has been realized that it is a systemic disease characterized histologically by non-caseating granulomata. An aetiological agent eludes characterization. A number of recognizable patterns of disease at presentation are documented includirrg Lofgren’s syndrome (2). Lymph node enlargement is frequently found in sarcoidosis, occurring in up to 90% of p&&nts during the course of their disease. The most cemmon pattern of mediastinal adenophy is bilateral involvement of the bronchopulmonary, right paratracheal and aortopulmonary nodes, but any combination can occur (3). Despite this, the incidence of obstruction of the intrathoracic vasculature is low. To the authors’ knowledge, only four reports of superior vena caval(4-7) and pne of innominate vein (8) obstruction due to sarcoid are described in the literature. No cases of subclavian vein obstruction have been reported previously. Obstruction of vessels can be caused by two mechanisms: involvement of the vessel wall with granulomata or extrinsic compression by enlarged lymph nodes. In the present case, the obstruction has been demonstrated radiograhically (Plate 1) to be due to external compression by intrathoracic lymphadenopathy; however, concurrent microscopic involvement of the vessel wall could not be excluded. The diagnosis of sarcoidosis in this case is supported by many factors: the initial presentation of uveitis and lymphadenopathy, abnormal pulmonary physiology which improved with oral corticosteroids, the positive Kveim, the intrathoracic biopsy material obtained, and the raised serum ACE during the current recrudescence. The subsequent course of the illness and response to therapy would not be typical for any other granulomatous disease. To the authors’ knowledge, this case is the first to present on two separate occasions with intraothoracic venous obstruction, the second with an increase in activity of disease. At present, the symptoms have resolved with anticoagulation and corticosteroid therapy.