A 93-year-old lady presented to the hospital complaining of 3 weeks of dysphagia, weight loss, dyspnea, and audible wheezing. Two days after admission, she was intubated and placed on assisted mechanical ventilation due to severe respiratory distress. A chest radiograph (CXR) showed a curvilinear, well circumscribed left superior paramediastinal opacity with suspected underlying mass (Figure 1, Panel A, arrow). Computed tomography (CT) of the chest with intravenous contrast revealed a large cystic mass measuring 9.3 x 6.4 x 4.6 cm, extending from the left supraclavicular region, immediately inferior to the thyroid gland, to the left hilar region (Figure 1, Panel B, arrow). The patient underwent open thoracotomy, where mass communication to the thoracic duct was noted, and complete surgical excision of a cyst filled with turbid and pale yellow fluid was achieved. Pathology report confirmed the diagnosis of a pleural cyst. The patient had no recurrence on CT and CXR after 4 weeks..