Mantle cell lymphomas are uncommon subtypes of non-Hodgkin's lymphoma with poor overall survival ranging from 3-5 years. Patients are often middle aged men who would present with generalized lymphadenopathy and typical constitutional symptoms. Extranodal disease is typically found in the gastrointestinal tract, liver, spleen, and central nervous system. Lung involvement is typically restricted to parenchymal lesions. Endotracheal involvement is quite uncommon with less than 5% of cases. We present an unusual case of treated mantle cell lymphoma recurring 7 years later with only endotracheal involvement demonstrated by fluorodeoxyglucose-positron emission tomography.