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Failure of the vitelline veins to regress as expected during embryonic development may lead to long-term consequences for neonatal patients. This case report describes a full-term infant born with a persistent vitelline vein, after prenatal ultrasound at 32 weeks suggested the presence of multiple venous system malformations. Postnatal imaging, including ultrasound and contrast computerized tomography (CT), confirmed a thrombus within the persistent vitelline vein, in addition to several hepatic embolic infarcts. Persistent aneurysmal vitelline vein with a thrombus is a rare diagnosis that has been previously managed with surgical interventions. This case demonstrates the multi-disciplinary decision to proceed with conservative medical management, and the subsequent resolution of both the thrombus and persistent vitelline vein with anticoagulation alone.