Primary mediastinal large B-cell lymphoma rarely causes clinically significant pulmonary artery compression. Acquired or secondary pulmonary stenosis is an uncommon condition and is usually caused by extrinsic compression from mediastinal masses, aneurysms or enlarged lymph nodes. Compression of the main pulmonary artery by an anterior mediastinal tumour is particularly rare because these masses generally enlarge laterally rather than anteroposteriorly. We report a 24-year-old man presenting with dyspnoea and constitutional symptoms. Imaging demonstrated a large anterior mediastinal mass with pleural effusion, while echocardiography showed compression of the main pulmonary artery with turbulent flow and a peak gradient of 40 mmHg. This case highlights an unusual cause of secondary pulmonary stenosis and the value of echocardiography in evaluating mediastinal masses.
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