Solitary fibrous tumours are a rare group of tumours that originate from connective tissues such as the pleura and mediastinum. When growing within the thoracic cavity these tumours exert pressure on vital organs and large vessels. We have successfully operated on two patients with large solitary fibrous tumours and managed the pathophysiological changes manifested as superior vena cava syndrome resulting from these tumours.

A 31-year-old male amateur bodybuilder presented with a 2-year history of chronic pain over the sternum and a clicking sensation in the chest wall on movement. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) showed no cause for his symptoms. Dynamic ultrasound scan performed at a specialist sports center revealed pseudoarthrosis of the manubriosternal joint (MSJ). After a period of conservative management (rest and analgesia), he failed to improve and underwent debridement and fusion of the MSJ with plates and screws. At follow-up 23 months later, he remains pain-free and has returned to weight lifting and bodybuilding.