This case involves a 35-year-old female with a history of non-cirrhotic portal fibrosis, splenectomy, recurrent tuberculosis, and recurrent bouts of hematemesis and fever. She presents with cyanosis, clubbing, and shortness of breath. Testing reveals findings consistent with hepatopulmonary syndrome, including low oxygen saturation that decreases further in an upright position. A contrast echocardiogram confirms intrapulmonary vascular dilations. She is diagnosed with severe, longstanding hepatopulmonary syndrome secondary to non-cirrhotic portal hypertension.