This 39-years old man presented with breathlessness and edema and puffiness of the face. The CT scan showed a large anterior mediastinal mass involving the SVC (blue arrow). There was pleural effusion on the right (green arrow) and lung nodules (red arrow) as well. The differential is aggressive thymic neoplasm, lymphoma and malignant germ cell tumor.

The biopsy was simple using a right parasternal approach with an 18G coaxial biopsy gun.

The diagnosis was thymic carcinoma.