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Teratomas are interesting because of their obscure origin,bizarre microscopic appearance and sometimes unpredictable behaviour.Although they occur infrequently in children, clinician should be aware of their clinical features, natural history, pathology and principles of treatment.In an attempt to document some of the features ,we report a case of an infant with large mediastinal teratoma presenting with severe and recurrent respiratory distress. Patient was operated successfully with no recurrence in 1 year follow up.