Respiratory manifestations of systemic disease — clinical case

Case summary

This boy presents with the classic and dangerous picture of an anterior mediastinal mass: a dry cough, breathlessness worse when lying flat, facial and neck swelling with distended veins, and stridor when supine, together with the B-symptoms of weight loss and night sweats that suggest lymphoma. The essential insight is that his respiratory signs are the manifestation of a systemic malignancy compressing the airway and great vessels, and that this is a peri-procedural emergency long before it is a routine oncology referral. ^[1]