Pediatric germ cell tumor(GCT) with extensive tumor thrombus of inferior vena cava(IVC) presenting as an oncological emergency is extremely rare .Thirteen months female child with sacrococcygeal GCT having IVC and right atrial thrombus presenting with anasarca and respiratory distress is reported. Due to worsening symptoms post initiation of chemotherapy tumour thrombus debulking from right atrium and distal end of IVC was performed on day 9 on emergency basis. Her symptoms improved and after planned chemotherapy tumor excision with coccygectomy could be done. The IVC thrombus remained inoperable due to sclerosis. She remains recurrent-free now 12 months post therapy.