Chest
Volume 88, Issue 2, August 1985, Pages 244-248
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Clinical Investigations
Stenosis of Main Bronchi Mimicking Fixed Upper Airway Obstruction in Sarcoidosis

https://doi.org/10.1378/chest.88.2.244Get rights and content

An unusual site and cause of disabling inspiratory and expiratory airflow limitation mimicking fixed upper airway obstruction is reported in two patients with sarcoidosis who had stenosis of almost the entire lengths of both main bronchi. The observed flows were consistent with a cross sectional airway diameter of 3 mm. The lumen of the trachea and proximal airways was not compromised.

Section snippets

Case 1

A 32-year-old black woman was first seen in March of 1982 with marked exacerbation of her usual dyspnea and noisy respirations. She had a history of “asthma” beginning in 1977 attributed to working with “hot glue” at a cardboard carton factory. She had had no previous pulmonary or allergic symptoms or illness and was a nonsmoker. She had received workmen's compensation and had had repeated admissions to other hospitals for her symptoms, with PaCO2 values up to 50 mm Hg. After intensive care

Discussion

The locus of obstruction in both main bronchi, rather than in the upper airways, makes the clinical presentation and physiologic alterations otherwise characteristic of fixed UAO noteworthy.

Patient 1 had no clinical evidence of sarcoidosis other than the enlarged lacrimal glands which provided the clue for obtaining a tissue diagnosis. For several years, she had been mistakenly treated for “occupational asthma” because of progressive respiratory distress and “wheezing” which was really stridor.

ACKNOWLEDGMENT

This investigation was supported by the Jack Martin Fund.

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    Manuscript received October 22; revision accepted December 20.

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