Is this a calcified mediastinal germ cell tumour I see before me?

The diagnosis of calcified mediastinal germ cell tumour (GCT) in children is rare [Billmire et al. Malignant mediastinal germ cell tumours: an intergroup study. Journal of Paediatric Surgery 2001;36(1):18-24]. This was a suspected diagnosis in a female infant admitted to the Royal Brompton Hospital (RBH) following a five-month history that included recurrent episodes of dyspnoea, stridor, persistent coughing and lower respiratory tract infections that were resistant to treatment. This article examines the clinical and radiological evaluation of this patient and the role of image manipulation in interpretation of the plain chest radiograph.