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An 82-year-old woman presented with blood-stained regurgitation, an episode of melena and exertional dyspnea during the preceding month. She had a history of hypertension and aortic stenosis, for which she was receiving medication. Gastrointestinal endoscopy revealed esophageal varices, but clinical examination and routine laboratory testing showed no features of liver cirrhosis or hepatitis of viral or autoimmune etiology. Abdominal computed tomography (CT) scan showed findings of liver congestion but no signs of liver cirrhosis. Shearwave elastography confirmed the presence of liver fibrosis. Transthoracic echocardiography revealed remarkably elevated pulmonary artery systolic pressure (PASP) >100 mmHg, severe tricuspid regurgitation, moderate mitral regurgitation, mild aortic stenosis, and moderate aortic regurgitation. Based on the combination of the findings of the transthoracic echocardiogram, abdominal CT and shearwave elastography, we attributed this patient's portal hypertension to congestive liver fibrosis (CLF), which was a consequence of pulmonary hypertension due to left-sided multivalvular heart disease. She was treated with diuretics with quick relief of her symptoms. [ABSTRACT FROM AUTHOR]