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An 82-year-old woman presented to the ED with unintentional weight loss and progressive difficulty breathing and swallowing over several months. Her dyspnoea was worse when sitting upright. On examination, there was audible stridor at rest, (online supplemental file 1 (video)), which disappeared when she was reclined at 45°, and when flat. Neurological examination showed partial blepharoptosis and pupillary miosis on the right, findings compatible with right-sided Horner syndrome (figure 1). There was non-tender swelling of the entire right arm present (figure 2).
Contributors MAA cared for the patient clinically, selected the relevant radiological images, consented for and conducted clinical photography and produced the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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