Actinomycosis is a slowly progressive infection caused by anaerobic or microaerophilic bacteria, primarily of the genus Actinomyces that colonize the mouth, colon, and vagina. Mucosal disruption might lead to infection nearly at any site within the body. The clinical presentations of actinomycosis are myriad. Thoracic actinomycosis is a very rare condition contributing 15% of actinomycosis cases. Here we present a rare case of cervicothoracic actinomycosis presenting as superior venacava syndrome. Actinomycosis is uncommon, and most physician's personal experience with its clinical presentations is limited. Actinomycosis remains a diagnostic challenge, even for a skilled clinician as it mimics tuberculosis and malignancy. Actinomycosis has been called the most misdiagnosed disease, and it has been said that no disease is so often missed by experienced diagnosticians.