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Sacrococcygeal teratoma (SCT) is the most common tumor of the newborn. Diagnosis is clinical and frequently straightforward. However, varied presentations can occasionally result in a diagnostic dilemma. We present a case of ruptured cystic Altman Type 1 SCT along with pertinent review of literature. The purely cystic variant of SCT is rare in itself and presenting as a ruptured lesion added to the dilemma in diagnosis and management.