Liver disease can lead to complications that affect your lungs, such as the buildup of fluid around your lungs or high blood pressure in the arteries that lead to your lungs from your heart.

Your liver has more than 500 functions.

Liver disease occurs when the functional cells inside your liver can’t perform all their tasks efficiently. More than 4.5 million people in the United States have liver disease.

Difficulties with your liver can cause complications involving other organ systems. Some people with liver disease develop lung difficulties such as:

  • increased pressure in arteries leading to your lungs
  • fluid buildup around the lungs
  • bacterial lung infections
  • poor oxygen and carbon dioxide exchange

Here, we examine the potential lung complications of liver disease and how they’re managed.

Up to 70% of people with cirrhosis evaluated for a liver transplant experience trouble breathing due to lung complications. Here’s a look at the main lung difficulties that develop as a result of liver disease.

Hepatic hydrothorax

Hepatic hydrothorax is a type of pleural effusion. Pleural effusion is a buildup of fluid around your lungs. It’s been suggested to occur in 5–16% of people with cirrhosis.

Researchers don’t fully understand why liver disease causes hepatic hydrothorax, but most people also have fluid buildup in their abdomen called ascites. The currently favored hypothesis is that it might develop from the movement of fluid through the diaphragm from the abdominal cavity.

People with mild hepatic hydrothorax may not have noticeable symptoms. In severe cases, it can cause a complete lung collapse.

The most common symptoms include:

Spontaneous bacterial empyema

Spontaneous bacterial empyema is when a bacterial infection develops in the presence of hepatic hydrothorax.

The infection can potentially develop due to bacteria in your blood, bacteremia, or from infected fluid in your abdomen that reaches your lungs.

Some studies from Taiwan have estimated that spontaneous bacterial empyema occurs in 13–16% of people with cirrhosis and hepatic hydrothorax.

Symptoms can include:

  • shortness of breath
  • fever
  • chest pain
  • cough

Hepatopulmonary syndrome

Hepatopulmonary syndrome affects about 5–32% of people with cirrhosis. It’s characterized by the widening of the blood vessels in your lungs. This widening of the blood vessels compromises their ability to uptake oxygen.

The exact cause of hepatopulmonary syndrome isn’t clear, but it’s thought that the dilation (widening) of blood vessels in the lungs might occur due to the buildup of chemicals normally cleared by your liver.

About 82% of people have symptoms of liver disease before developing hepatopulmonary syndrome symptoms. When symptoms do appear, they often include:

  • severe shortness of breath
  • low blood oxygen levels
  • bluish fingertips or other parts of your skin, which is harder to see on darker skin
  • club-like appearance of fingers
  • breathlessness in the upright position that’s improved when lying down (platypnea)

Portopulmonary hypertension

Portopulmonary hypertension is characterized by pulmonary arterial hypertension associated with portal hypertension.

Pulmonary arterial hypertension is high blood pressure in the arteries that carry blood from your heart to your lungs. Portal hypertension is high blood pressure in the veins that lead to your liver.

Portopulmonary hypertension might be caused by:

  • an imbalance in chemicals that tell your blood vessels to expand and relax
  • increased stress on your blood vessels
  • increased inflammation
  • blood clots originating from the veins that lead to your liver
  • genetic predisposition

Potential symptoms include:

Portopulmonary hypertension eventually leads to right heart failure if not treated.


Pneumonia is one of the most common infections in people with liver disease. It’s usually caused by an infection from viruses or bacteria.

The prevalence of pneumonia in people with cirrhosis has been reported as high as 21.4% with a mortality rate between 37–41%.”

Symptoms of pneumonia include:

Lung complications of liver disease may be reversible in some cases. For example, pneumonia may be treatable with antibiotics. But the development of lung problems is often a sign of advanced liver disease, and people with this disease have a poor outlook.

Liver transplantation is the only known effective therapy for hepatopulmonary syndrome.

Only about half of people with hepatic hydrothorax survive more than 8–12 months, and spontaneous bacterial empyema has a mortality rate of around 30%.

The 5-year survival of portopulmonary hypertension has been reported at under 50%.

Doctors use many treatments to manage lung complications of liver disease. Here’s a look at some of these treatments and when they’re used:

sodium restrictionreduce fluid retention• hepatic hydrothorax
diureticsreduce fluid retention• hepatic hydrothorax
paracentesisdrain abdominal fluid• hepatic hydrothorax
thoracentesisdrain fluid from around your lungs• hepatic hydrothorax
• spontaneous bacterial empyema
transjugular intrahepatic portosystemic shuntcreate a new connection between two blood vessels in your liver• hepatic hydrothorax
liver transplantationreplace you liver• hepatic hydrothorax
• portopulmonary hypertension
• hepatopulmonary syndrome
pleurodesisstick your lung to the wall of your chest to prevent fluid buildup• hepatic hydrothorax
antibioticskill bacteria• spontaneous bacterial empyema
• pneumonia
antiviral or antifungal medicationskill viruses or fungi• pneumonia
albumin therapyimprove circulatory and kidney function• spontaneous bacterial empyema
pulmonary dilator therapyrelax blood vessels in the lungs• portopulmonary hypertension

If you have liver disease, it’s important to see a doctor or other healthcare professional if you notice any symptoms involving your lungs. Some of these symptoms may be unrelated to your liver disease. A doctor or other healthcare professional can run tests to determine the underlying cause.

Developing lung complications is often a sign of advanced liver disease that has a poor outlook for people with this disease.

A doctor or other healthcare professional can recommend the best treatment for any complications you develop. Severe liver disease may require a liver transplant.