Endobronchial obstruction of the left middle lobe

A 48-year-old woman reported a 1-year history of breathlessness, persistent cough and recurrent chest infections. She was a former smoker with a medical history of nasal polyps and asthma since childhood. She was managed as a case of worsening bronchial asthma, until a CT scan was performed to investigate anaemia, incidentally identified an obstructing lesion in her left main bronchus (figure 1). She was referred to our specialist interventional bronchoscopy unit for further investigation and management. A review of her imaging disclosed a pedunculated soft tissue lesion obstructing the distal left main bronchus and presence of left-to-right axis switching of the aorta and inferior vena cava with polysplenia (figure 1). All abdominal organs were normally sited. Figure 1 (A) Chest x-ray showing dextrocardia and partial left lower lobe collapse (B) CT chest with contrast demonstrating left hilar lesion on axial view (see arrow & red circle) (C) Coronal view showing lesion in distal …