UNLABELLED: Congestive heart failure in the neonate is usually due to intracardiac anomalies or cardiac dysfunction. Extracardiac causes are rare. PATIENT: We report a newborn infant who presented with respiratory distress and cardiomegaly. RESULT: Echocardiography identified a dilated right subclavian artery and vein and superior vena cava. Magnetic resonance imaging confirmed a subclavian artery to subclavian vein fistula that was treated with surgical ligation. The infant recovered fully. This case underscores the need for clinical suspicion of fistulous connection in unusual locations in the face of unexplained heart failure in the neonate. CONCLUSION: Echocardiographic and magnetic resonance imaging are effective noninvasive modalities to confirm the diagnosis prior to surgical intervention.