Mediastinal tuberculosis without lung involvement is an uncommon finding in an immunocompetent adult. We report the case of an 80-year-old male smoker who presented with dyspnea and stridor. He was found to have a mass in the middle mediastinum which also involved the anterior wall and 50% lumen if of the lower trachea. Histology and mycobacterial cultures of the lesion led to the diagnosis of mediastinal tuberculosis. Antituberculous treatment led to complete resolution of airway symptoms and reduction in the size of the mediastinal mass.