An 18-year-old female patient presented with lump hypogastrium since one month. Lump was initially small in size but increased progressively to attain the present size. She also complained of non-specific, non-localized abdominal pain which was chronic, dull aching in nature, and nonradiating. It was mild in severity with no aggravating or relieving factors. Bladder and bowel habits were normal. She had an irregular menstrual cycle of 30–60 days, 1–2 days duration and scanty flow. She had no history of previous medication or hospitalization. On examination, two discrete tender lumps, 7–9 cm in size and firm in consistency, and well-defined margins present in hypogastrium. Per vaginal examination could not be performed due to denial of consent due to virgin status. All laboratory investigations were within normal limit except hemoglobin which was 5.9 mg% and low T3 0.10 ng/ml (normal 0.7–2.0 ng/ml), low T4 1.2 lg/dl (normal 5.5–13.5 lg/dl), and high TSH 102 llu/ml (normal 0.3–5.0 llu/ml) levels. CA 125 and other tumor markers were within normal limits. Ultrasonography at the time of admission showed bilateral enlarged ovaries of size 15.22 9 8.26 cm(Rt. Ovary) and 11.82 9 6.24 cm (Lt. ovary) with multiple cysts of varying sizes in both ovaries, giving a classical ‘spoke wheel-like appearance.’ A diagnosis of bilateral ovarian cysts was made, and diagnostic laparoscopy was planned for further management. On pre-anesthetic cardiopulmonary evaluation, pericardial effusion was suspected. Hence, cardiology opinion was taken and subsequent echocardiogram revealed massive pericardial effusion. Then, on the basis of previous findings and echocardiogram put together, a diagnosis of spontaneous Singh A. (&), Senior Resident Singh K., Ex.Senior professor and Head Of Department Khandelwal R. G., Assistant Professor Choudhary P., Post Graduate Student Sharma V. K., Post Graduate Student Department of Surgery, J. L. N. Medical College, Ajmer 305001, India e-mail: dr.amit5280@gmail.com Dr. Amit Singh completed his M.B.B.S from Dr Sampurnanand Medical College, Jodhpur, 2005, and M.S in general surgery from Jawaharlal Nehru Medical College, Ajmer, 2011. Presently, he is Senior Resident at Jawahar Lal Nehru medical college, Ajmer. His keen area of interest is hepatobiliary and gastrointestinal surgery. He has many international and national publications. The Journal of Obstetrics and Gynecology of India (March–April 2015) 65(2):132–135