Picture Quiz: A case of mediastinal shift

An 86 year old woman with a background of hypertension and arthritis presented to our medical assessment unit with 3 weeks history of mild dyspnoea and central chest discomfort. She did not have any past history of respiratory problems. She denied any cough, hemoptysis or weight loss. There was no significant family history. She was a life long non smoker and used to drink alcohol occasionally. She was taking enalapril 5 mg and amlodipine 5 mg daily. She was living alone and was independent and self caring.