Purpose <p>A 13-month-old boy presented with persistent and worsening stridor since four months of age. Microlaryngoscopy and bronchoscopy (MLB) revealed posterior tracheal compression. A CT scan identified a cystic mediastinal mass, likely an oesophageal duplication or bronchogenic cyst.</p> Methods <p>The patient underwent video-assisted thoracoscopic surgery (VATS) for cyst excision.</p> Results <p>The cyst occupied the right thoracic inlet, extending from the supraclavicular region to the tracheal bifurcation, displacing the superior vena cava (SVC), oesophagus, trachea, and great vessels. A meticulous dissection was performed posterior to the SVC whilst downward pressure was applied on the neck, allowing better visualization of the cyst. Two traction sutures were placed in the cyst wall for easier dissection. The lesion was carefully separated first from the arch of the aorta and then from the oesophagus using a linear stapler. The cyst was successfully removed without complications. The patient showed significant improvement in respiratory symptoms postoperatively.</p> Conclusion <p>This case demonstrates the successful minimally invasive management of a complex mediastinal cyst causing tracheal compression in an infant. Downward pressure at the thoracic inlet was a simple and effective way to reveal the cyst internally. Our approach and surgical techniques may guide aspiring paediatric surgeons handling similar lesions.</p>