Pulmonary complications may occur as a result of end-stage liver disease, probably due to decreased hepatic clearance or increased hepatic production of circulating cytokines and other vascular growth mediators. We report a case of a female Egyptian patient 15-year-old that presented with cyanosis who was investigated for a long time for being a cardiac patient as she showed no symptoms suggestive of liver affection but eventually she was diagnosed to have hepatopulmonary syndrome. We aim to highlight pulmonary affection secondary to hepatic disease that although rare can lead to significant morbidity in patients with liver cirrhosis.