to a course of steroids but has now recurred is consistent with partial treatment of lymphoblastic leukemia or lymphoma Many lymphomas present with nonspecific systemic symptoms such as weight loss, fatigue, unexplained fevers, night sweats, and malaise Itching can be a paraneoplastic phenomenon associated with Hodgkin lymphoma Examination should include assessment of all nodal groups (including axilla and supraclavicular) to both aid in the differential diagnosis and establish a site for possible biopsy Of note, almost all pediatric lymphomas are high grade and have an acute to subacute course The initial focus should include a thorough assessment of airway, breathing, and circulation, all of which may be compromised by an AMM When an AMM compresses the airway below the level of the carina, intubation will not be effective in managing respiratory failure Management must focus on prevention of respiratory failure through such strategies as oxygen therapy and maximizing respiratory mechanics Do not place the patient with respiratory distress in the supine position Do not sedate or anesthetize the patient as this can lead to airway obstruction or cardiovascular collapse Do not start empiric steroids without a discussion with an oncologist to ensure that steroids will not interfere with ability to establish the diagnosis If there is evidence of SVC syndrome (plethora, facial edema, and jugular venous distention), ensure adequate intravascular volume to support systemic return