We present a case of a one day old neonate that appears at premature birth -33 weeks of pregnancy with a huge cervical mass causing severe difficulties of breathing. First the child was intubated admitted in the ICU .Here my colleagues from Neonatology department struggle to sustain the vital functions with mechanical ventilator ,parenteral feeding , transfusion etc. ..Diagnosis of the nature of the mass was made clinically and confirmed by ultrasonography, lab tests finally histopathology .A computer tomography of the neck, or a biopsy were not possible immediately because of prematurity , severe pulmonary complication .The surprise was to discover that the mass was a congenital goiter associated with and a right later cervical cystic hygroma -a rare lymphatic malformation . It was impossible to discover a genetic relation between the diseases or a teratogenic external cause to explain the concomitant neck lesion.i. The purpose of the report is not only to present such a rare case, association between a giant. congenital goiter with a lymphangioma\but most important to discuss the difficulties related with the management of such a case. Example-difficult delivery., severe respiratory distress and difficulties to intubate because of deviation of the larynx.ii. If for the diagnosis a CT scan and laboratory test are enough, is more important if the problem is diagnosed intrapartum using ultrasonography and if is an important compression on the airways a MRI will evaluate the mass for an eventual EXIT treatment.iii. The treatment unfortunately is very difficult and dangerous because important vessel and nerves are included in the mass, plus high risk of hemorrhage, infection, plus risk of general anesthesia. Another point was our intention to discuss, what is the best attitude facing such a, problem algorithm of diagnosis and treatment.