Hodgkin’s lymphoma is a neoplastic proliferation of Reed Sternberg cells and inflammatory cells within the lymphatic system. Common symptoms associated with Hodgkin’s Lymphoma include pronounced lymphadenopathy, fever, polynuclear leukocytosis, and anemia.1,2This case study presents a unique case where an adult patient with nodular sclerosing Hodgkin’s lymphoma (NSHL) presents with rapidly progressing dyspnea due to tracheal airway narrowing. CT results showed pathological lymph nodes in bilateral cervical stations, subclavian images and within the mediastinum, concerning for lymphoproliferative disease. Otolaryngology was consulted for a possible tracheostomy; however, an awake fiberoptic intubation was suggested and subsequently performed instead. This case demonstrates the importance of immediate intervention to prevent airway loss in an atypical presentation of NSHL.TopicsNodular sclerosing Hodgkin’s lymphoma, airway loss, intubation.