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From 1972 through 1974, 5 infants with severe respiratory distress secondary to mediastinal tumors were treated in the Division of Pediatric Surgery of The Johns Hopkins thospital; The mediastinal masses included 2 intramural bronchial cysts, a giant esophageal duplication, a benign teratoma, and a highly malignant neuroblastomamindividualized management was carried out successfully in all: total resection of the bronchial cysts and teratoma; partial resection of the duplication cyst with stripping of the remaining mucosa from the contiguous esophageal wall, thereby preserving esophageal integrity; and excision of involved chest wall and tumor combined with radiotherapy and chemotherapy for the neuroblastoma. This experience emphasizes the potential for lethal respiratory distress from mediastinal tumors in infants and supports the experience reported by others of serious consequences if resection is not performed. Primary physicians and thoracic surgeons must be aware of the lethal potential of such mediastinal tumors among the many other "surgical" causes of respiratory distress in neonates and infants.