Introduction: Hepatic hydrothorax is that occurs in individuals with decompensated cirrhosis of the liver. Approximately 5 % of cases of pleural effusion occur in patients with cirrhosis and ascites. Although quite rare, it is associated with higher morbidity and lower survival rates. The mechanism is not fully understood, but the most widely accepted pathogenesis involves the presence of portal hypertension, diaphragmatic defects, and negative intrathoracic pressure. In this case, the pleural effusion occurs because of the direct displacement of peritoneal fluid through the small openings in the diaphragm into the pleural space. We aimed to study its clinical features and natural history.