We describe the case of a female patient, 21 years old, complaining of dyspnea attacks and wheezing 2 years ago. Chest radiography showed volume loss in the left lower lobe and ipsilateral retrocardiac triangular basal opacity. CT scan showed an extensive solid mass with apex protruding into the left main and lower lobar bronchi, causing distal atelectasis. Histopathological and immunohistochemical study of transbronchial biopsy of the lesion revealed a typical carcinoid tumor, confirmed after tumor resection with total left pneumectomy.Keywords: Carcinoid Tumor. Endobronchial. Pulmonary. Typical. Diagnostic Imaging.case report A female 21-year old patient presenting dyspnea and wheezing attacks for two years. She is overweight, has polycystic ovary syndrome and is currently using oral contraceptives. She does not smoke. The patient reported that three radiographs in the past 6 months revealed consolidation in the left lung base. During this period, treatment regimens for pneumonia were used, without clinical or radiological improvement. On auscultation, rhonchi and wheezing were audible at the base of the left hemithorax. Laboratory tests did not point out any abnormalities.A new chest X-ray showed loss of volume in the left lower lobe with triangular basal retrocardiac opacity, apex directed towards the ipsilateral hilum and base next to the diaphragmatic dome ( Figures 1A and 1B).Computed tomography (CT) imaging showed a solid expansive mass with apex protruding into the left source bronchus ("tip of the iceberg" sign 1 ), causing partial obstruction and distal subsegmentar atelectasis, as well as marked enhancement following intravenous contrast administration (Figures 2A, 2B, 2C and 2D).After bronchofibroscopy, which confirmed the endobronchial lesion, the anatomopathological and immunohistochemical investigation of the transbronchial biopsy material showed a well-differentiated (typical) carcinoid tumor ( Figures 3A, 3B and 3C). A CT scan of the abdomen performed for staging failed to show other neoplastic formations. The therapy selected was left total pneumonectomy, which confirmed the histological finding of tumor in a subsequent investigation.

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We describe the case of a male patient, aged 76 years, referred for cardiac investigation due to retrosternal chest pain and dyspnea. He had a history of acute myocardial infarction and angioplasties in the last 30 years, including a saphenous vein coronary artery bypass grafting (SVCABG). Echocardiogram showed hypoechoic oval formation near the right ventricle, suggesting a pericardial cyst. Computed angiotomography revealed a predominantly fusiform and thrombosed aneurysmal dilation of the SVCABG to the right coronary artery. SVCABG aneurysms are very rare and potentially fatal. They usually appear in the late postoperative period, and patients are often asymptomatic. On radiography, it is frequently presented as enlargement of the mediastinum, with echocardiography, computed tomography and magnetic resonance imaging being very useful for diagnosis. Coronary angiography is the gold standard to detect these cases. Our report illustrates a rare situation arising late from a relatively common surgery. Due to its severity, proper recognition in the routine assessment of patients with a similar history is essential.Keywords: aneurysm, bypass, coronary, saphenous, myocardium. case reportMale patient, 76 years old, underwent complementary investigation through imaging examinations due to complaints of retrosternal chest pain and mild dyspnea several months ago. The patient reported hospitalization and clinical treatment of acute myocardial infarction one month before. The patient had hypertension, dyslipidemia, was a former smoker and had a history of two other acute myocardial infarctions prior to 2010. The patient's history included saphenous vein coronary artery bypass grafting (SVCABG) for about 30 years, two percutaneous transluminal coronary angioplasty procedures, one with stenting to clear the SVCABG, and surgical repair of abdominal aortic aneurysm with endoprosthesis for approximately 4 years. Reports of catheterizations prior to 2015 described new SVCABG occlusion.A chest radiograph showed only a metallic sternal suture and a small stent near the cardiac silhouette ( Figure 1A and B).The echocardiogram showed a hypoechoic, elongated oval image, adjacent to the right cardiac chambers, causing a slight extrinsic compression on diastole ( Figure 2A and B), apparently without flow according to color Doppler investigation. The diagnostic possibility of pericardial cyst was raised.Computed tomography of the thorax showed a large, oval and elongated hypoattenuating (approximately 45 HU) mediastinal mass with lobulated contours, located in close contact with the right heart chambers, presenting peripheral parietal calcifications with a maximum caliper of 4.9 cm and measuring approximately 10.0 cm in length ( Figure 3A-C), not enhanced after the injection of intravenous contrast medium ( Figure 3D-F). The mass could be seen from the emergence of the ascending aorta, with the small stent evident in its interior, extending even to the lower cardiac wall. Such findings were compatible with thrombosed SVCABG aneurysm...