Background: Anterior mediastinal mass can lead to life threatening airway compression and impingement on heart and great vessels. Mortality is high, especially in children, due to pliable rib cage and difficulties in symptomatic assessment preoperatively. Respiratory symptoms include dyspnea, orthopnea, cyanosis, cough, wheeze, and stridor. Cardiovascular symptoms include syncope, headache, and facial swelling that worsens with Valsalva, and on physical examination jugular venous distention, facial/neck oedema, blood pressure changes with postural changes, and increased pulsus paradoxus.