INTRODUCTION
Bronchiectasis is a heterogeneous disease featured by irreversible
airway dilatation with chronic bronchial infection and inflammation (1).
The conditions that directly affect airway clearance, such as ciliary
dyskinesia, obstruction or cystic fibrosis, can lead to accumulation of
secretions, causing what is called the “vicious cycle hypothesis” (2).
The accumulation of secretions leads to infection, bronchial dilatation,
resulting in more accumulation, closing the cycle. (2,3) In rare
settings, this constant cycle can ultimately create a retracted and
atelectatic lung resulting in a mediastinal shift. This can have
technical, clinical, and physiologic implications especially in patients
with end-stage lung disease requiring lung transplantation. We report
two uncommon patients presenting complete atelectasis of right lung with
a prominent shift of the mediastinum to the right side who underwent
successful sequential double lung transplantation.