Clinical history

Pneumonectomy for bronchogenic carcinoma (squamous cell) 1 year before. Follow-up.

Radiological findings

Frontal chest radiograph. Opacity of the left hemithorax with ipsilateral mediastinal shift. Ill-defined right hilum and downward displacement of the minor fissure. Triangular opacity projecting over the heart limited by the displaced minor and major fissures (arrows). The hilum is enlarged and the major fissure bulges posteriorly suggesting a hilar mass (Golden sign). Retrosternal lucency (star) due to the anterior transthoracic herniation of the right lung.

CT findings

Axial, coronal and sagittal CT reformations. The triangular opacity is due to a middle lobe atelectasis with characteristic displacement of fissures. Axial CT at the top of the atelectatic middle lobe. Hilar solid mass encasing the intermediate bronchus and obstructing the middle lobe bronchus.

Extra Examinations

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Final diagnosis

Biopsy during fiberoptic bronchoscopy. Recurrence of the squamous cell carcinoma on the contralateral lung.

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