<p>Most prenatal/neonatal pulmonary masses are non-neoplastic congenital bronchopulmonary malformations. However, both benign and malignant primary pulmonary neoplasms do occur. While rare, these neoplasms can be difficult to differentiate from one another, as well as from other congenital and some acquired pulmonary lesions, including occasional mediastinal and chest wall masses. Misdiagnosis or delayed identification of a pulmonary neoplasm can result in incorrect or delayed management decisions and therapy, adversely affecting outcomes. Atypical timing of presentation, rapid growth, and unusual or heterogeneous imaging appearance should raise suspicion for a neoplastic lesion. There are some diagnostic and ultrasound, computed tomography, and magnetic resonance imaging features that help to differentiate these lesions, along with several useful genetic or biological identifying markers. This review will discuss and illustrate the clinical and imaging features of neonatal pulmonary neoplasms, as well as some of the conditions that are differential considerations.</p> Graphical Abstract <p></p>