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.