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An 80-year-old man was admitted to the emergency department with a 2-day history of general deterioration. His blood pressure was 93/66 mm Hg, heart rate 77 beats per minute, respiratory rate 26/min, peripheral oxygen saturation 93% on room air and body temperature 36.5°C. He has mild dyspnoea. Laboratory tests revealed a mild decrease in renal function and pyuria. The preliminary diagnosis was a urinary tract infection and prerenal acute renal failure. A bedside ultrasound was performed to evaluate cardiac function ( figure 1) and the inferior vena cava.