Primary diaphragmatic lipomas are rare. A 66-year-old female case is reported, with the unusual presentation of progressive dyspnoea leading to respiratory failure, mainly because of a large fatty mass occupying the base of the left hemithorax. The completely resected mass (16 x 14.5 x 5.5 cm) was a primary diaphragmatic lipoma. The literature is discussed. We recommend surgical exploration since the possibility of liposarcoma cannot be excluded.
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