Hepatic hydrothorax is an uncommon clinical problem observed in
patients with end stage liver disease and portal hypertension. The pathogenesis of pleural effusion in this condition is thought to involve the movement of ascitic fuid across diaphragmatic defects into pleural cavity facilitated by a negative pleural pressure. Therefore, tube thoracostomy is not considered to be a defnitive treatment option in the management of hepatic hydrothorax. We present a case of massive pleural effusion secondary to hepatic hydrothorax not responding to conventional treatment successfully treated with intravenous infusion of octreotide.