A 61-year-old man presented with a dry cough and dyspnoea. On examination, persistent hypoxaemia without clinical signs of respiratory distress was observed. After the most common causes of hypoxaemia were ruled out, hepatopulmonary syndrome was suspected because of his medical history of liver cirrhosis. Further diagnostic testing including serial arterial blood gas analysis and contrast enhanced transthoracic echocardiography supported the diagnosis. As liver transplantation is currently the only available curative treatment, the patient was referred to a transplantation centre. Hepatopulmonary syndrome is a rare but severe pulmonary complication of several liver diseases, characterised by arterial deoxygenation and intrapulmonary vascular dilatation. When left untreated it has a high mortality rate. Early recognition may increase survival and lower perioperative transplantation risks. Therefore, when encountering a case of unexplained hypoxaemia in a patient with liver disease, the possibility of hepatopulmonary syndrome should be considered. © 2018, Netherlands Society of Intensive Care. All rights reserved.