Introduction: Neuroblastoma is the most common extracranial solid tumor in childhood and the leading malignancy in infants. It arises from neural crest cells of the sympathetic nervous system and most commonly originates in the adrenal glands or paraspinal sympathetic ganglia. Thoracic neuroblastoma may present with respiratory symptoms and radiographic findings that mimic pneumonia, potentially leading to delayed diagnosis. Prognosis varies widely from spontaneous regression to more aggressive forms. Early detection and personalized care improve outcomes. Case presentation: A 27-day-old male infant, born after an uncomplicated pregnancy , presented to base hospital with cough, stridor, and tachypnea of one day’s duration. Chest radiography showed right upper zone opacification, and he was initially treated for right upper lobe pneumonia. Due to poor response to treatment, baby was transferred to tertiary care hospital for further evaluation. An upper gastrointestinal contrast study revealed oesophageal indentation suggestive of external compression. Contrast-enhanced computed tomography demonstrated a solid mass in the right upper hemithorax measuring 50 × 45 × 30 mm. The mass was surgically excised, and histopathology confirmed poorly differentiated neuroblastoma. Sixweeks later, magnetic resonance imaging revealed residual paravertebral tumor with spinal cord compression and liver metastases, although there were no clinical signs of cord compression or liver derangement. The patient underwent chemotherapy , resulting in complete resolution of the residual tumor and metastatic lesions. Conclusion: Neuroblastoma should be considered in neonates presenting with persistent respiratory symptoms or poorly resolving pneumonia with chest radiographic opacification. Early recognition and appropriate management are essential to improve outcomes.