PMC3622622_01
Pre-operative chest X-ray (Figure 1a) and computed tomography (Figure 1b) revealing complete mediastinal and cardiac right-shift.
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F1
Pre-operative chest X-ray and computed tomography revealed an unusually pronounced mediastinal shift to the right (Figure 1a and b).
2a-d: 3D-Volume Rendering (approximately 20  RAO and 10  superior view) for surgical planning. Segmentation volumes of bony chest structures, heart, aorta and aortic braches and abdominal organs were generated using threshholding and semiautomated segmentation techniques. Image characteristics (such as colour or transparency) of the individual anatomic structures could then be deefined separately allowing interactive 3D-visualization of the spatial relationship of the anatomical structures. 2e: 50 mm maximum intensity projection slab (slab orientation approximately 20  RAO and 10  superior corresponding to Figure 2a-d) of the aortic arch showing the calcification of the aortic valve. No significant calcifications of the aortic arch.
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F2
Despite presumptive severe adhesions following right pneumonectomy and following further pre-operative planning using 3D-volume rendering of the CT-data set (Figure 2a-f), it was decided to perform surgery via minimally invasive right anterolateral thoracotomy.