Attempted jugular vein cannulation in a patient with a discrete goitre resulted in a rapid growing haematoma and airway obstruction. This life-threatening complication is rare, and is usually related to two conditions: pre-existing coagulopathy and/or arterial puncture by a large bore cannula or vessel dilator. None of these was present in this patient. Investigations revealed a retrosternal goitre causing tracheal compression and major changes in the calibre and the anatomical relationships of neck vessels. Possible origin and mechanism for the sudden haematoma are discussed, as well as the airway management. This case clearly illustrates how internal jugular vein cannulation using the traditional blind technique, guided by external landmarks, can be extremely hazardous in patients with distorted anatomy of the neck.