Early liver ultrasound (US) performed to find a source of sepsis in a 52-year-old female suspected to have developed intraabdominal sepsis. Visualized here are: normal-sized liver, punctuated hyperechoic foci with anti-gravitational distribution (yellow arrows) casting acoustic shadows (red arrows). Due to characteristic appearance on liver US, the most likely diagnosis was hepatic portal venous gas (HPVG) [1,2]. Other less likely diagnoses were: pneumobilia due to cholangitis, hepatic micro-abscesses, and punctuate calcifications. Hepatic portal venous gas detected by US following liver transplantation or in suppurative cholangitis were described previously [3,4]. Although presence of mesenteric ischemia and gas in the portal venous circulation was previously revealed with computed tomography [5,6], in our case early abdominal US was performed, what expedited definite diagnosis and targeted treatment: choice of empiric broad-spectrum antibiotics and explorative laparotomy. This is the first time, to the best of our knowledge, that HPVG was visualized with US in the setting of acute mesenteric ischemia.