Background <p>Emphysematous cholecystitis is a rare and rapidly progressive disease that requires prompt diagnosis and intervention. Point of care ultrasound (POCUS) is a useful diagnostic imaging tool in the emergency department that can help expedite diagnosis and management of biliary etiology.</p> Case presentation <p>In our case, we describe an 85 year old female with a history of diabetes mellitus with a presentation consistent with undifferentiated cholecystitis. Point of care ultrasound performed in the emergency department showed a characteristic “champagne sign”, along with other findings including dilated common bile duct and pericholecystic fluid. These findings ultimately led to the diagnosis of emphysematous cholecystitis and acute cholangitis. The use of ultrasound expedited the patient’s cholecystostomy tube placement and subsequent endoscopic retrograde cholangiopancreatography, proving to be a life-saving tool in the management of this patient.</p> Conclusion <p>POCUS can be an important tool for the diagnosis of undifferentiated biliary etiology, expediting the management of these patients.</p>