56 years-old female patient with hipertension and hipothiroidism. Later on, we also discovered she's a usual alcohol drinker. Sent by his doctor for abdominal ultrasound, she refers symptoms of anroxia, asthenia, refluxes and billy vomiting for the lasta six months with hypertransaminasemia. No fever or infectious symptoms.Ultrasound iin Primary Care: hepatomegaly and signs of chronic hepatopathy, moderate ascitis and splenomegaly that suggest portal hypertension.The results of the ultrasound with the symptons and blood test results, we decided to send the patient to the emergency services in order to confirm the results and considerer hospital admission. The patient stayed for two months at the hospital where, she also had a liver biopsy and ended up being study in hematology service due to leukocytosis with neutrophilia, after an immunophenotype they found monocystosis at the expense of classical monocytes that suggests chronic myelomonocytic leukemia.Obviously, it was not in primary health care where all the estudies and the final dignose of the patient was done, but we did the ultrasound and found symptons of portal hypertension, that allowed us to submit the patient inmediatly to the hospital.So the ultrasound in our day to day practice is very useful resource that can help to detect patients that needs an urgent attentionIf we couldn't have done an ultrasound in primary care, the diagnose of portal hypertension could have been delayed for months, so having acces to imaging studies as ultrasound as well as training family doctors in its use, is very valuable tool not only for the patient, but for the healthcare system.