Congenital heart failure in the neonate supported by classic imaging findin
gs may allow the implementation of medical therapy for presumed hemangioend
othelioma without obtaining a tissue diagnosis. This case report describes
a neonate with these classic clinical and radiographic findings but who und
erwent surgery for failing medical treatment and was diagnosed as having a
hepatoblastoma by pathology. This case supports the need to obtain tissue c
onfirmation before beginning medical therapy.