28th February 2025

A 62-year-old gentleman with a 40 pack-year smoking history presents with a 4-week history of progressive dyspnoea

A 62-year-old gentleman with a 40 pack-year smoking history presents with a 4-week history of progressive dyspnoea. He reports a puffy face, tight shirt sleeves and headaches. On examination, inspection reveals oedema of the upper torso, upper limbs and face and dilated veins in the neck. He is struggling to complete sentences. A portable chest X-ray demonstrates a widened upper mediastinum and he is commenced on high-flow oxygen and high-dose steroids. His case is referred through the appropriate MDT meeting and a CT-guided biopsy is performed on the third day of admission.

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