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The authors focus on a physiopathologic manifestation, most often misdiagnosed, which present as a "lipomatous-like mass in the supraclavicular fossa". This is generally at the origin of sophisticated radiologic tests and, not infrequently of useless biopsies. The paper analyzes the different reasons leading, alone or in combination, to the phenomenon by which the mediastinal fat is pushed toward regions where no limits anatomic structures exist, such as the supraclavicular fossa. Knowledge of the above causes, together with a careful physical examination plus a standard postero-anterior-X-ray can easily lead to a correct diagnosis of "pseudotumor of the supraclavicular fossa", avoiding costly and needless diagnostic and therapeutic interventions.