Background: Extra-abdominal presentations are rarely seen in ovarian germ cell tumors (OGCT). We report a case of a patient with OGCT who presented with systemic venous thrombosis, pulmonary infarct, and chylothorax simultaneously. Case Presentation: A 13-year-old girl presented with dyspnea, fever, and cough of 1 week duration. She was detected to have left-sided chylothorax. Carcinoma Antigen 125 and alpha fetoprotein levels were raised. Computed tomography showed a large ovarian mass, and thrombi in superior vena cava, left brachiocephalic vein, and segmental branch of right pulmonary artery. She also had a peripheral opacity in the right lung with a reverse-halo sign, suggestive of pulmonary infarct. She was diagnosed with yolk-sac tumor and managed with anticoagulation and subsequently neo-adjuvant chemotherapy and surgery. Conclusion: Prothrombotic state in OGCT can lead to systemic thrombosis which may result in chylothorax due to obstruction of thoracic duct. The phenomenon, though rare, should be kept in mind during management of OGCT.

Keywords: varian germ cell tumor, chylothorax, pulmonary infarct, reverse-halo sign, systemic thrombosis, yolk-sac tumor, case report.