The mediastinum is the most common site of chest mass in a child, but mediastinal masses often pose a management challenge to the clinician. Due to the difficulty in access and the well-ensconced position of the masses, they pose diagnostic and therapeutic challenges. They may be incidentally detected on plain radiographs or can be symptomatic and present with respiratory distress and other symptoms. About 30–40% of mediastinal masses in children are malignant.