Taking advantage of the Byzantine civil war of 1341–1347 by alternately supporting both sides of the conflict, the Serbian king Stefan Dušan expanded his state southwards, conquering Albania and most of Macedonia by 1345, with the exception of the great fortress cities of Serres and Thessalonica.

[4] This growth in power made Serbia the de facto dominant state in the Balkans, and fuelled Dušan's imperial ambitions: already in early 1343, the Serbian ruler elevated his titles to "tsar and autokrator of all the Serbian and Maritime Lands and čestnik of the Greek [Byzantine] Lands".

Notably, when the Byzantines came around to recognizing Dušan's imperial title, it was only for Serbia proper, much as they had done with the Bulgarian Tsar Simeon four centuries earlier.

With the extinction of the main line of the Nemanjić dynasty with the death of heirless Stefan Uroš V in 1371, the imperial title became obsolete.

The fall of the Serbian Empire saw the state fragmenting into provinces ruled by magnates, holding various titles, except the imperial.