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Anterior mediastinal masses pose significant anaesthetic challenges, primarily due to the risks of airway compression and haemodynamic instability. We present the case of an adolescent with an anterior mediastinal mass causing severe tracheal and vascular compression, necessitating urgent diagnostic biopsies. Given the high risk associated with general anaesthesia, the procedure was performed under local anaesthesia in conjunction with clinical hypnosis. This approach was well tolerated, successfully avoiding deep sedation and airway manipulation.As the initial biopsies were inconclusive, an excisional lymph node biopsy was subsequently performed using the same anaesthetic strategy, incorporating both the hypnosis protocol and local anaesthesia. This procedure confirmed the diagnosis of Hodgkin lymphoma, enabling the prompt initiation of chemotherapy.This case underscores the potential role of clinical hypnosis as an adjunct to local anaesthesia in enhancing patient comfort and cooperation, particularly when general anaesthesia presents substantial risks.