Chest CT scan with contrast enhancement was performed after 5 months from the initial CT scanning (after seven cycles of chemotherapy). The image shows markedly decreased size of the mediastinal mass, leading to improvement in dyspnoea, and left arm oedema. Residual pericardiac effusion and thin diffuse pericardial enhancement were seen in addition to a huge mass encircling the oesophagus, mediastinum and lower neck, and metastatic lymphadenopathy.