A 71-Year-Old Man With Neck Pain, Ptosis, and Complex Cystic Superior Mediastinal Lesion

A 71-year-old man sought treatment at the emergency department with a 3-week history of posterior neck pain, generalized weakness, and new-onset right-sided ptosis. He described the neck pain as sharp (6 out of 10) and nonradiating, with a sensation of neck "dropping" that required intermittent manual repositioning and support with a neck brace. Pertinent positive findings included increased fatigue, dizziness, loss of balance, and excessive sleep. Pertinent negative findings included recent trauma, travel, sick contacts, chest pain, shortness of breath, nausea, vomiting, abdominal pain, altered bowel or urinary habits, headache, and fever. His past medical history included dyslipidemia, nephrolithiasis, and benign prostatic hyperplasia. He reported that he does not smoke or consume alcohol and has no occupational exposure risks.