Introduction: Lymphangioma is an atypical non-malignant tumor. It is most commonly observed in pediatric population and typically found in the cervical region. Its prevalence is estimated between 0.01% and 4.5% of all mediastinal tumors. Complete surgical resection is required to prevent recurrence.
Case Report: We present the case of a 47-year-old male with massive right pleural effusion. Magnetic resonance imaging showed a massive mediastinal cystic lymphangioma. A radical excision of the thymus and lymphangiomatosis cystic mass was performed by sternotomy. The postoperative course was marked by simultaneous hemopericardium, hemoperitoneum and hemothorax, the origin of which, was not well explained due to its presentation in the distal site of surgery. This required transfusions and new thoracoabdominal surgical exploration. The patient developed pulmonary and wound infections and died of sepsis and multi-organ failure.
Conclusion: Our case would be a further demonstration of an unusual complication of simultaneous hemopericardium, hemoperitoneum and hemothorax explained by some authors as a local production of fibrinolysin.

Keywords: Cystic lymphangioma, Hemoperitoneum, Hemothorax, Mediastinum neoplasm, Pericardial effusion