Fat-containing pleural mass due to spillage of an ovarian dermoid cyst

A 48-year-old female presented with worsening right-sided chest pain and a complex pleural process 3 months after undergoing ovarian dermoid cyst removal. Extensive preoperative workup was nondiagnostic except for radiographic imaging suggestive of a pleural lipoma given the presence of fat within the lesion. Thoracotomy with decortications demonstrated granulomatous inflammation without infection or a neoplastic process. We suspect spilled material during the dermoid removal likely crossed through the diaphragm into the pleural space and caused the reaction. Operative technique and proper position of the patient should reduce this risk of contaminating pleural space during dermoid cystectomy. Clinicians should use vigilance for a possibility of abdominal pathology causing pleural diseases. Similar to pleural effusions due to cirrhosis of liver, ovarian tumors, peritonitis, and hepatic abscess, intraoperative spillage from a dermoid cyst can lead to significant pleural disease.