A 38-year-old man presented to The Prince Charles Hospital Emergency Department with a six-day history of neck swelling and four-week history of cough. They described reduced exercise tolerance, shortness of breath and feeling like they have "been doing a handstand for hours" when leaning forward. The patient identifies as a Torres Strait Islander, currently working on the mainland in the mines. On examination the patient appeared very clinically fit and well with bilateral neck swelling, right more than left, and tender palpable right sided cervical lymphadenopathy. The clinical presentation was highly suspicious for SVC syndrome with differential diagnoses including infection, pneumothorax with surgical emphysema and malignancy. CT thorax revealed a large soft tissue mass in the mediastinum with mass effect causing almost complete obstruction of the superior vena cava. On the initial CT report there was concern the mass could represent an angiosarcoma. The patient was referred to the local respiratory inpatient team however due to the potential  diagnosis of angiosarcoma, consideration of direct transfer  to the local quaternary hospital was considered. The patient remained in The Prince Charles Hospital for further investigations to dilineate the diagnosis.  An ultrasound neck identified a lymph nodal mass in the right supraclavicular region causing extrinsic compression of the right jugular vein. Biopsy confirmed a diagnosis of Non-Hodgkin T-Cell Lymphoma. High dose dexamethasone improved the patient's neck swelling and he was discharged home with outpatient oncology follow up for further management. This case highlights the vigilance clinicians in the Emergency Department must uphold in identifying rare presentations of medical emergencies as well as difficulties in specialty referral caused by premature diagnostic presumptions.