The Golden S Sign.

A 60 year old male farmer, chronic smoker, presented with complaints of productive cough since 1 month, swelling of the face and neck since 3 weeks and dyspnoea since 10 days, which was worse at night. There, was history of loss of appetite and considerable weight loss. There was no history of fever. On examination vitals were stable. The patient had right cervical lymphadenitis and right supraclavicular lymphadenitis. There was edema of face, neck and bilateral upper limbs. There was evidence of dilated veins over right arm, chest wall and suffusion of conjunctiva. On examination of the respiratory system, movements were reduced on the right side with dull note in right supramammary region. Vocal resonance was increased in the corresponding area. Breath sounds were reduced in the right inframammary, infraaxillary and infrascapular areas. Examination of cardiovascular and central nervous system was normal. Per abdomen examination revealed no abnormality.