Meigs syndrome — the classic triad of benign ovarian tumour, ascites, and pleural effusion — is a well-recognised yet diagnostically treacherous mimic of advanced ovarian malignancy. We report a 34-year-old nulliparous woman who presented with a 30–32-week-size solid right adnexal mass, bilateral pleural effusions necessitating intercostal drainage, haemodynamic compromise, and a markedly elevated serum CA-125 of 629 U/mL. Colour Doppler sonography showed absent internal vascularity, and computed tomography of the chest revealed bilateral effusions with mediastinal shift. For more visit: https://medwinpublishers.com/OAJG/meigs-syndrome-masquerading-as-advanced-ovarian-malignancy.pdf