Clinical history

80 y-o woman. Operated on for aortic stenosis. Respiratory problems during the post-operative period.

Radiological findings

Bedside chest radiograph after cardiac surgery. Enlarged of the upper mediastinum. Its cause remains undetermined: positioning or true mediastinal enlargment.

CT findings

Axial CT sections. Mediastinal enlargement by a band of tissue (star) containing dilated bronchi plastered against the mediastinum and limited by the sagittaly orientated minor fissure (arrows). Forward displacement of the right major fissure. Emphysema and thoracic distention.
Coronal CT thick reformation. Atelectatic upper lobe with bronchi filled in by secretions (arrows). Stenosis of the origin of the right upper lobe bronchus without any obstructing mass.
Sagittal CT thick reformation. Triangular appearance of the right upper lobe. No detected mass responsible for the obstruction.

Extra Examinations

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Final diagnosis

Fibroscopy: Severe stenosis of the origin of the right upper lobe bronchus without endobronchial mass. Multiple biopsies did not demonstate any feature of malignancy. Final diagnosis: chronic marked atelectasis of the right upper lobe in a woman suffering from chronic obstructive lung disease.

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