Ascites and hydrothorax are common complications of liver cirrhosis, however, unilateral isolated hepatic hydrothorax without associated ascites is an unusual and challenging complication of liver cirrhosis. Though rare, this condition often poses both diagnostic and therapeutic dilemma, especially in patients without other symptoms or risk factors for cirrhosis. It usually leads to prolonged hospitalization and may cause early mortality. Unilateral isolated hepatic hydrothorax may also be the only pointer to underlying cirrhosis in the absence of ascites. Liver transplantation remains the only definitive treatment for this condition.