Abstract: The diagnostic criteria of Meigs syndrome are the presence of ascites and hydrothorax in association with a benign solid ovarian tumor and spontaneous resolution of ascites and pleural effusion on tumor resection. The case of a middle aged woman who died suddenly at home without significant history of illness is presented. Autopsy found a large left ovarian fibroma (which was confirmed histologically), ascites and bilateral pleural effusion with collapsed lungs. The commonest gynecologic causes of sudden death are ruptured ectopic pregnancy and induced abortions. Two case reports of death associated with Meigs syndrome were identified in the literature; both were diagnosed before the patients died. Literature search found no publication on “sudden death associated with Meigs syndrome.” This is probably the first report of sudden death associated with Meigs syndrome. The terminal cause of death in this case was collapsed lungs (atelectasis). The autopsy investigation of ascites and or pleural effusion associated with an ovarian mass or lesion should always include consideration of Meigs syndrome. Sudden death associated with Meigs syndrome (undiagnosed in life) in a middle aged female is described, and selected literature on the condition reviewed.