<h3>Introduction</h3> Ovarian cancer is the most lethal gynecologic malignancy and in 75% of cases are diagnosed in advanced stages unfortunately 30% of patients with advanced ovarian cancer present pleural effusion at the time of initial diagnosis, that has been associated with worse disease-free survival and overall survival. <h3>Description</h3> A 48-year-old women who present a 3-month history of bloating and abdominal pain. Tomography of the abdomen and chest showing left pleural effusion with bilateral adnexal masses, peritoneal carcinomatosis and a ca 125 of 1753. The patient was given 4 chemotherapy cycles with partial imaging and serological response. Control images showed persistence of pleural effusion in the left hemithorax that was previously compromised by adenocarcinoma, so it was decided to perform left thoracoscopy to define secondary pleural involment. The main finding during thoracoscopy is evidence of a 5 cm lesion at the level of the left diaphragmatic peritoneum with full full thickness infiltration with no other lesiones in pleura cavity. The patient was taken to a complete abdominal cytoreduction by laparotomy with an adequate clinical evolution pending the restart of chemotherapy. <h3>Conclusion/Implications</h3> It is important to mention that metastatic involvement of pleural effusion has a high correlation with pleural involvement. The main prognostic factor for overall survival in ovarian cancer is complete cytoreduction, thats why we must establish the areas affected by this neoplasm and define the possibility of undergoing surgery. Video asisted thoracoscopy is a low-morbidity procedure that allows us to evaluate pleural and mediastinal involvement in patients with pleural effusion.