Introduction: Ganglioneuroblastomas are transitional tumors of sympathetic nervous system which have intermediate malignant potential between neuroblastomas and ganglioneuromas. Neuroblastic tumours account for approximately 10% of all paediatric population. Here we present a case of a 6-year-old girl who presented with refractory bronchial asthma. Her routine chest x-ray showed a mediastinal mass and subsequently led to the diagnosis of ganglioneuroblastoma. Case presentation: She has a background of poorbronchial asthma and presented with acute onset shortness of breath. She was managed as an acute severe episode of bronchial asthma. She showed minimal response to conventional medication including magnesium sulphate. An Urgent chest radiograph was arranged which showed a right sided opacification with a right middle lobe collapse and a tracheal deviation to the right. She was further evaluated with a CT scan of chest which showed a right moderately enhancing retrocaval lesion at the level of adrenal gland with calcification. The biopsy was performed and diagnosed as a ganglioneuroblastoma. She was screened for metastasis with a bone scan, bone marrow aspiration and a 2D echocardiogram. All were found to be normal. She received 4 cycles of chemotherapy followed by surgical excision. Discussion and Conclusion: Ganglioneuroblastomas are common in children less than 10 years and arise from primitive neuroectodermal cells of the adrenal gland and sympathetic chain. In X-ray , they can be visualized as mediastinal, cervical or retroperitoneal masses. This case report emphasizes the importance of obtaining a chest x-ray in a patient who is not responding to the standard acute asthma management.