A 77-year-old woman presented to the emergency department complaining of shortness of breath. The patient reported similar, less severe episodes in the past. Initial vital signs were a respiratory rate of 30 breaths/min and a heart rate of 106 beats/min. Clinical examination was unremarkable with the exception of inspiratory stridor and an enlarged goitre over her left neck. Chest radiography revealed a right neck mass causing compression of the trachea and displacement to the right (fig 1). Computed tomography confirmed the presence of mass about 10.5 cm in size in the left thyroid gland. The patient received total thyroidectomy. Her symptoms resolved completely and she was discharged home uneventfully.

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Figure 1 Chest radiograph revealing a right neck mass causing compression of the trachea and displacement to the right.

The patient with goitre and the physician frequently overlook symptoms of upper respiratory obstruction. Conventional radiology is the accepted method for detecting upper airway obstruction in these patients.1 In this case a chest radiograph helped to make the diagnosis and computed tomography confirmed it.