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A hiatal hernia causing or aggravating ascites by compressing the hepatic veins has been rarely reported in adults. We report a patient with a known hiatal hernia who was presented with refractory ascites. Echocardiography and CT examination demonstrated a huge hiatal hernia compressing the right atrium and the inferior vena cava. A right-sided heart catheterization demonstrated a significant pressure gradient between the inferior vena cava and the right atrium. Liver biopsy showed a nodulardoi:10.14740/jmc1559w fatcat:jggwjmqc7vchncwixgf3tuy5fm