case_images: PMC11788711_01
case_images: Computed tomography (CT) and chest X-ray (CXR) imaging demonstrating a large mixed-density mediastinal mass causing right main bronchus compression and right middle and lower lobe collapse: (a) sagittal, (b) coronal, (c) axial, and (d) AP-CXR.
case_images: cureus-0017-00000076890-i01.jpg
case_images: PMC11788711_01_cureus-0017-00000076890-i01.jpg
case_images: FIG1
case_images: Positron emission scan (PET-CT) imaging revealed an irregular 28 mm x 26 mm x 19 mm right upper lobe mass with central necrosis (Figure 1). Chest X-ray demonstrated compression of the right tracheobronchial take-off with the collapse of the right middle and lower lobes (Figure 1).
case_images: CXR post VVECMO cannulation.. Multistage access cannula at the cavo-atrial junction (blue arrow) and single-stage return cannula (red arrow) positioned in the mid-right atrium.. CXR, chest X-ray; VVECMO, veno-venous extracorporeal membrane oxygen
case_images: cureus-0017-00000076890-i02.jpg
case_images: PMC11788711_01_cureus-0017-00000076890-i02.jpg
case_images: FIG2
case_images: Post-intubation transoesophageal echo and CXR confirmed appropriate positioning of the ECMO cannula (Figure 2).
case_images: Fluoroscopy: Rigid bronchoscopy deployment of bifurcation wires to guide tracheal Y stent during apnoeic period.. The VVECMO single-stage return cannula is denoted by the white arrow.. VVECMO, veno-venous extracorporeal membrane oxygen
case_images: cureus-0017-00000076890-i03.jpg
case_images: PMC11788711_01_cureus-0017-00000076890-i03.jpg
case_images: FIG3
case_images: The patient promptly underwent ECMO-supported rigid bronchoscopy, tumor debulking, and cryobiopsy (Figure 3).
case_images: Postoperative AP CXR demonstrating reversed nitinol-coated Y stent (note: position with long left main bronchus projection intentionally deployed to the RMB) with sacrifice of the right upper lobe (RUL), but restoration of right middle lobe (RML) and right lower lobe (RLL) aeration.. AP CXR, anteroposterior chest X-ray; RMB, right main bronchus
case_images: cureus-0017-00000076890-i04.jpg
case_images: PMC11788711_01_cureus-0017-00000076890-i04.jpg
case_images: FIG4
case_images: The stent was asymmetrical, and in this case, the longer sidearm, typically reserved for the left main bronchus, was intentionally rotated and placed in the right main bronchus, as this provided sufficient extension beyond the margin of the residual luminal compression (Figure 4). Postoperative imaging demonstrated re-expansion of the right middle and lower lobes, but anticipated sacrifice of the right upper lobe (Figure 4).