Intestinal pneumatosis (IP) usually indicates an irreversible injury and transmural necrosis. Traditionally, abdominal radiography, especially CT imaging, has been used to diagnose IP. The first reported case of ultrasound being used to diagnose IP was in 1985. Most of the reports use endoscopic ultrasound,, or advanced Doppler imaging techniques, which are beyond the purview of the intensivist. On abdominal ultrasound, the circle sign was described in three patients, with the pattern being recognized when extensive gas bubbles were seen in the entire circumference of the bowel wall. Unfortunately, the demonstration of this sign requires high-resolution ultrasonography. The extremely low BMI of the patient along with the presence of ascites allowed us to demonstrate presence of air bubbles in the bowel wall even with the phased array probe (Fig 1). Ultrasound has also been used to demonstrate extraluminal intraperitoneal air, which can be distinguished from intraluminal air by the presence of an increased echogenicity of the peritoneal stripe and multiple reflection artifacts, including a characteristic comet tail artifact. Also, other nonspecific signs of bowel pathology, such as bowel wall thickening (> 3 mm), may also be seen. Gas bubbles seen on an echocardiogram or in the hepatic venous system have been used to diagnose IP as well.