A 61-year-old man initially presented to the emergency department for neck swelling of 10 days with findings of a firm palpable mass above the left clavicular space. Computed tomography of the neck and chest showed pathological mediastinal, hilar, and supraclavicular lymphadenopathy. Fine needle aspiration of left supraclavicular lymph node was performed by ENT; however, the aspirate was hypocellular and non-diagnostic. Subsequently, the patient was referred for endoscopic ultrasound-guided fine needle biopsy of mediastinal lymph nodes.