A 48-Year-Old Woman with Left Subclavian Artery Occlusion and Intrathoracic Lymphadenopathy

Sarcoidosis is a systemic disorder characterized by noncaseating granulomas, involving multiple organs including thyroid and great vessels. We present a 48 year-old women with sarcoidosis, left subclavian artery occlusion and sarcoidal thyroid gland involvement. The patient presented with a 1 week history of progressive left upper limb pain with coldness of left hand and fingers. On examination, radial, ulnar, and brachial artery pulses were not palpable. She had also enlarged thyroid gland with firm consistency. CT angiography of aortic arc demonstrated occlusion of left subclavian artery. Because of progressive ischemic necrosis of left hand and fingers, amputation above elbow was performed. Fine needle aspiration (FNA) was suspicious for thyroid neoplasm and total thyroidectomy was performed. Thoracic CT scan showed mediastinal and bilateral hilar lymphadenopathy. Fiberoptic bronchoscopy with transbronchial needle aspiration (TBNA) from right hilar lymph nodes and endobronchial biopsy showed multiple granulomas with negative acid-fast stain. Pathologic examination of thyroid also revealed fibrosis and granulomatous inflammation. On follow up, the ACE level was 104 u/l.