Lipomas are benign soft-tissue tumors comprised of encapsulated well-differentiated adipose tissue. These neoplasms can be located ubiquitously throughout the body; however, lipomas arising from the pleura are rarely observed. Pleural lipomas originate from adipocytes located beneath the mesothelial layer of the serosal lining. While commonly asymptomatic, lipomas may reach a significant size and thus cause compression of surrounding organs, resulting in symptoms. The symptoms are nonspecific and include chest pain, cough, and dyspnea. Since lipomas are often asymptomatic, the lesions are more often detected incidentally on radiologic imaging. The use of imaging, such as thoracic ultrasound, computed tomography, and magnetic resonance imaging, can be diagnostic. However, due to the potential size and appearance of pleural lipomas, the tumor can at times mimic liposarcomas and other pleural malignancies, necessitating histopathologic analysis. Tissue sampling via transthoracic biopsy is typically adequate for definitive diagnosis. Management can include periodic surveillance imaging for small asymptomatic lesions that demonstrate stability. Surgical resection is indicated for symptomatic or suspicious masses. Prognosis is excellent for both asymptomatic, stable pleural lipomas and lesions that require excision. Pleural lipomas are not subject to malignant transformation and typically do not recur, especially if completely excised. This chapter provides a comprehensive overview of pleural lipomas, encompassing their epidemiology, pathophysiology, clinical features, diagnostics, and therapeutic approaches with an emphasis on the importance of accurate diagnosis to avoid unnecessary interventions.