Introduction: Pneumatocele is a thin-walled, air-filled lung cavities form within the lung interstitium.It commonly seen in peadiatric age group and occur as a complication of pneumonia or as a sequela of trauma or mechanical ventilation. Most cases are asymptomatic and resolve with appropriate antibiotic therapy and follow-up, though persistent or complicated cases may require surgical intervention. Case history: A 1-year-10-month-old girl presented with one week history of high-grade fever, productive cough, and mild respiratory distress. She was tachypnoeic with intercostal recessions and bilateral crepitations. Chest X-ray demonstrated left-sided bronchopneumonia with pneumatocele formation. Despite empirical intravenous antibiotics, there was deterioration of the clinical status of the child and progressive enlargement and persistent collapse consolidations on serial imaging. CECT chest revealed a large left upper lobe pneumatocele causing mediastinal shift, residual left lower lobe consolidation, and a small left apical pneumothorax. In failure of the optimal medical treatment, she underwent left minithoracotomywith segmental lung resection. Conclusion: Pneumatocele are uncommon but very important complication in paediatricpneumonia which should not miss and are usually managed conservatively . However, the above case implies the importance of serial imaging in monitoring disease progression and guiding timely intervention. Early recognition of failure of conservative management andprompt surgical interventions can be life saving and may prevent further complications like pneumothorax. The case emphasizes the need of individual management strategies and close radiological follow-up in children with complicated pneumonia.