Cervicothoracic mass in the pediatric population is uncommon and has a broad differential diagnosis. Frequently, masses in the cervical region present with airway compromise, particularly in younger patients. We present a case of an extremely large cervicothoracic mass causing airway obstruction in a 3-day-old, otherwise healthy male infant. Following awake intubation for airway protection, a 4.5 cm x 2.5 cm x 1.5 cm thymic cyst was removed. This case illustrates the wide differential diagnosis of cervicothoracic masses and shows the difficulty of preoperative diagnosis, especially in the case of thymic cysts with extension into the cervical space.