Introduction: Neuroblastoma is an embryonal tumor of the sympathetic nervous system with marked clinical heterogeneity , ranging from spontaneous regression to aggressive, treatmentresistant disease. Case: A 1-year-3-month-old girl presented with a one-month history of right-sided neck swelling without respiratory or constitutional symptoms. Initial assessment at a local hospital showed right apical consolidation on chest X-ray . Neck ultrasound revealed multiple enlarged right upper and mid-jugular lymph nodes (largest 1.3 cm). Baseline blood investigations were normal and GeneXpert was negative. Despite antibiotic therapy , radiological changes persisted and she was referred for further evaluation. Notably , she had right-sided ptosis since seven months of age. Growth and development were normal. Examination revealed multiple matted, non-tender posterior cervical lymph nodes on the right without other lymphadenopathy . Right-sided ptosis was present without miosis, ophthalmoplegia, or facial anhidrosis. Systemic and upper limb neurological examinations were unremarkable. Laboratory investigations, including inflammatory markers and organ function tests, were normal. Contrast-enhanced CT of the neck, chest, and abdomen demonstrated a 4.1 × 3.9 × 3.9 cm right paraspinal upper thoracic mass with internal calcifications, extending from the root of the neck to the carina, displacing the distal trachea and esophagus, with adjacent spinal canal extension. Multiple right cervical lymph nodes compressed the internal jugular vein. Cervical lymph node biopsy confirmed poorly differentiated neuroblastoma. The child underwent surgical resection followed by chemotherapy . Conclusion: Persistent unilateral ptosis with non-resolving apical opacity in infancy should prompt evaluation for malignancy . Thoracic neuroblastoma can mimic pneumonia, and early imaging is crucial to avoid diagnostic delay .