Case Report It Is Always Early with Point-of-Care Ultrasound Zouheir Ibrahim Bitar , Tamer Mohamed Zaalouk, Ossama Sajeh Maadarani, and Ragab Desouky Elshabasy Critical Care Unit, Ahmadi Hospital, Kuwait Oil Company, P.O. Box 46468, 64015 Fahaheel, Kuwait Correspondence should be addressed to Zouheir Ibrahim Bitar; zbitar2@hotmail.com Received 20 December 2019; Revised 14 March 2020; Accepted 23 March 2020; Published 6 April 2020 Academic Editor: Chiara Lazzeri Copyright © 2020 Zouheir Ibrahim Bitar et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 56-year-old male was admitted to the emergency department for acute pulmonary edema and septic shock, yet no clear source of infection was noted upon physical examination. Due to his unstable condition, bedside ultrasound was performed. A heterogeneous mass in the liver was noted; hence, a tentative diagnosis of liver abscess was made. The abscess was confirmed by abdominal magnetic resonance imaging. Drainage of the abscess was attempted and guided by early ultrasound. This case highlights that point-of-care ultrasound, when performed by an ultrasound-capable critical care physician, can significantly decrease the time to diagnosis for septic patients. 1. Case File A 56-year-old male presented to our hospital’s emergency department complaining of acute shortness of breath and 1 week of malaise. He complained of nausea and vomiting in that period, with mild abdominal pain, but no diarrhea, cough, chest pain, or dysuria. He was known to have diabetes mellitus requiring insulin, hypertension, an old myocardial infarction followed by left anterior descending artery and right coronary artery stenting with borderline impaired sys- tolic function 6 months prior, and dyslipidemia. Upon examination, he had a Glasgow Coma Scale of 15, was shivering, hypotensive (mean arterial blood pressure 40 mmHg), tachycardic (140 beats per minute), tachypneic (34 breaths/min), hypoxic (peripheral oxygen saturation 82% on room air), and febrile (temperature of 38.9 ° C). An arterial blood gas on 6 L/min of oxygen through a BiPAP machine revealed a compensated acute metabolic acidosis, with a pH of 7.404, pCO2 15 mmHg, pO2 101 mmHg, HCO3 15.4 mmol/L, and lactate 4 mmol/L. The patient was in a hyperosmolar state with high blood sugar 30 mml/L and normal blood ketones. He was admitted to the critical care unit upon diagnosis of acute pulmonary edema and sus- picion of sepsis. The Rapid Assessment of Dyspnea with Ultrasound protocol [1] was immediately started and showed depressed systolic function of the left ventricle, with cardiac index 2 mL/min/m 2 , and ultrasound of the chest showed severe bilateral ultrasonic B lines suggestive of acute pulmo- nary edema. Clinically, there was still no obvious source of infection: he had a bilateral pulmonary crepitation and there was no abdominal or costovertebral angle tenderness. The patient’s blood pressure was still low after dobuta- mine infusion followed by noradrenaline infusion and con- trolled intravenous fluid with insulin infusion; because the patient continued to be unstable, a bedside ultrasound exam- ination for critically ill patients was performed to further look for a source of infection. Ultrasound revealed a heteroge- neous mass seen in segments IV (at the level of the left portal vein of the left lobe), VIII and V (at the level of the right por- tal vein of the right liver lobe), and I (caudate lobe) of the liver with no obvious intrahepatic biliary dilatation. The larg- est mass measured 10 × 7 cm (Figure 1). A thickened wall of the gall bladder with gall stones and biliary mud was also seen suggestive of acute cholecystitis. A liver abscess was suspected. An abdominal magnetic resonance imaging scan was then performed, which confirmed the abscess with no obvious intrahepatic biliary dilatation; the mass measured 9:5× 9:3×9:5 cm of volume 435 cc seen predominately involv- ing segments IV and I (Figure 2). Piperacillin-tazobactam and metronidazole had already been administered. Urgent Hindawi Case Reports in Critical Care Volume 2020, Article ID 9431496, 3 pages https://doi.org/10.1155/2020/9431496