Background: Neuroblastoma is the most common extracranial solid tumor in children, typically arising from the adrenal glands or abdominal sympathetic chain. Thoracic involvement, particularly in the posterior mediastinum, is rare and may present with nonspecific respiratory symptoms. When adjacent cardiac structures are compressed, clinical severity increases, posing diagnostic and therapeutic challenges.
Case Presentation: A one-year-old girl presented with persistent wheezing and recurrent pneumonia unresponsive to antibiotics. Initial imaging suggested pulmonary sequestration, but further evaluation—including echocardiography and angiography—revealed a posterior mediastinal mass compressing the left atrium and ventricle. Biopsy confirmed neuroblastoma. No metastasis was found on staging. Classified as intermediate-risk, she was treated per the Children’s Oncology Group (COG) A3961 protocol with chemotherapy. Treatment was well-tolerated, symptoms improved, and follow-up imaging showed significant tumor reduction without complications or recurrence.
Conclusion: Posterior mediastinal neuroblastoma may mimic common respiratory illnesses, delaying diagnosis. Cardiac compression can worsen symptoms and increase risks. Early recognition, accurate diagnosis, and multidisciplinary care are essential for favorable outcomes, as demonstrated by this case with no treatment complications or tumor recurrence on follow-up.