Meigs syndrome is a rare clinical entity of benign origin in which a triad of ovarian tumour (usually ovarian fibroma or fibroid-like tumour), hydrothorax and ascites co-exist and raise suspicion of malignancy. Here, we report the case of a 60-year-old female presenting with a suspicion of ovarian cancer with pleural fluid and ascites, although eventually found to be of benign origin and curated after resection of the tumour. By presenting the case, we emphasise the importance of meticulously evaluating the differential diagnosis in patients with suspected advanced cancer in the absence of pathological confirmation. Moreover, we raise awareness for the complexity of evaluating which patient categories could benefit from intensive care treatment. In this specific case, with the absence of a pathological diagnosis, the option of benign cause is important to consider, even when possible malignancy interacts with a patient’s wishes for treatment. © 2023, Netherlands Society of Intensive Care. All rights reserved.