Central airway obstruction (CAO) and superior vena cava (SVC) syndrome are potentially life-threatening complications in locally advanced lung cancer. Therapeutic rigid bronchoscopy has become an critical component in the treatment of the lung cancer patients with CAO who are not surgical candidates. However, the technique may pose significant risks in patients with coexisting SVC syndrome, especially, and even more so perhaps in patients over the age of eighty. In this case report, we address the potential risks and known benefits of therapeutic bronchoscopic intervention in an 85-year-old man with small cell lung cancer who presented with acute dyspnea secondary to advanced SVC syndrome and CAO involving the lower trachea and right main bronchus. Emergent therapeutic rigid bronchoscopy resulted in a marked improvement, in dyspnea, atelectasis, and postobstructive pneumonia, allowing rapid administration of systemic chemotherapy.