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Large abdominal masses increase intra-abdominal pressure, thus changing the hemodynamics of the patient by elevating the diaphragm and causing partial occlusion of the inferior vena cava (IVC). Large abdominal masses present many challenges, including life-threatening risks due to severe cardiovascular, pulmonary, and circulatory problems, as well as technical difficulties of surgery and postoperative complications. We report a case of a large pelvic-abdominal myoma with perioperative pulmonary compromise. The goal of this report was to familiarize other surgeons with the alterations in the pathophysiology and management of large abdominal masses.