Cryptogenic cirrhosis is a common cause ofliver-related morbidityand mortality in the United States. Nonalcoholic fatty liverdisease (NAFLD) is now recognized as the most common cause ofcryptogenic cirrhosis. However, the diagnosis of cirrhosis inpatients with NAFLD appears to be delayed compared with thosewith other chronic liverdiseases and thus carries a highermortality rate. This delay in diagnosis is illustrated in ourcase of a 53-year-old man who presented with hepatic hydrothoraxand ascites, whose workup revealed cirrhosis due to NAFLD. Althougha diagnosis of presumed NAFLD can be made noninvasively, a definitivediagnosis requires a liverbiopsy specimen. A biopsy specimenis also important for detecting histologically advanced disease,which may be clinically silent and undetected by aminotransferasesor diagnostic imaging. Although there are no proven treatments,recommendations for patients with NAFLD include avoidance ofhepatotoxins and aggressive management of associated conditions,such as hypertriglyceridemia and type 2 diabetes mellitus.