We report the case of a 53-year-old woman admitted to the intensive care unit (ICU) due to bilateral intraparenchymal hemorrhage requiring mechanical ventilation. Following the insertion of a nasogastric tube, the hepatic ultrasound reveals the presence of multiple heterogeneous hyperechoic images (Fig. 1). Microbubbles were also identified, on M-mode, in the portal vein and its visible branches (Fig. 2). A follow-up ultrasound performed 8h later confirmed the disappearance of all these findings (Fig. 3).

Figure 1

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Figure 2

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Figure 3

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These events are indicative of aerobilia due to the infusion of air for epigastric region auscultation of the correct placement of the nasogastric tube, which is probably in the duodenum with an incompetent papilla.