Combined Extra- and Intrathoracic (Dumbbell) Lipoma Crossing the Third Intercostal Space

Intrathoracic lipomas are uncommon, and dumbbell (hourglass) lesions with contiguous extra- and intrathoracic components are exceedingly rare. Surgery is indicated for enlarging or symptomatic tumors or when imaging raises concern for malignancy (e.g., infiltration). Complete resection - via thoracotomy or video-assisted thoracoscopic surgery (VATS) - provides definitive histopathologic diagnosis, cures benign disease, and helps prevent future compressive complications. We report a 53-year-old woman with a combined extra- and intrathoracic lipoma managed with a left oblique parasternal (subpectoral) incision and uniportal VATS. Complete removal was achieved, and histopathology confirmed lipoma. The postoperative course was uneventful, with discharge on postoperative day four. A brief review of the literature is also provided.