An older patient was admitted to the ICU in septic shock. Her periphery was almost not perfused and showed signs of cyanosis. Laboratory signs of consumption coagulopathy without haemolysis were presented. Measurement of cardiac output showed sufficient values which did not correspond with the severity of peripheral hypoperfusion. Anticoagulation and supportive therapy ware started. Performed CT scan excluded an occlusion of mesenteric vessels; however, it revealed diffuse changes of mesenteric vessels with slow and delayed filling by the contrast agent.

Patient´s condition improved after the initial administration of fluids. However, after several hours, shock progressed, and brief CPR was necessary. The patient aspired massively during CPR.

Next day, when you came to a night shift, you find the patient in the preterminal state.


Lung ultrasound, echocardiography and abdominal ultrasonography were all performed with following findings:

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