Hepatic hydrothorax is defined as the presence of a pleural effusion in a patient with cirrhosis and no evidence of underlying cardiopulmonary disease. It results from the movement of ascitic fluid into the pleural space through defects in the diaphragm and is usually right-sided. The negative intrathoracic pressure generated during inspiration favors the passage of fluid from the peritoneal to the pleural space. Thus, many patients have only mild or no clinically detectable ascites. Patients usually present with shortness of breath, cough, hypoxemia, and/or chest discomfort.