Summary

We present a case of unusual presentation of stridor in an adult man who was identified to have a sudden expansion of a foregut duplication cyst in the mediastinum. This resulted in superior vena caval obstruction and subsequent airway compromise. Following resuscitation, the cyst was surgically removed via a thoracotomy which confirmed the diagnosis and provided definitive management. Foregut duplication cysts are an unusual cause of stridor in adults, with only five cases ever documented worldwide in the literature, presenting in such a manner. This case is a reminder of the importance of thorough clinical examination, the benefits of radiology as an indispensible adjunct and essential role of the multidisciplinary team.