Background <p>Urosepsis, due to obstructing urinary calculi, is a urologic emergency requiring surgical decompression to reduce mortality. Presenting symptoms include fevers, pain, and dysuria, however, symptoms may be difficult to assess in patients with shock and altered mental status. Point-of-care ultrasound (POCUS) is an invaluable tool to assess patients in the emergency department (ED) with undifferentiated shock. We present a case series of three patients presenting with septic shock, who were found to have hydronephrosis on POCUS, from an infected ureteral stone.</p> Case presentation <p>Three elderly patients presented to the ED with sepsis secondary to an infected kidney stone. POCUS identified hydronephrosis leading to the diagnosis of infected ureteral stone as the nidus of the infection. These patients presented with atypical symptoms, and POCUS was essential to making the diagnosis and rapid source control.</p> Conclusion <p>POCUS is a useful tool for evaluating patients with shock in the ED. Numerous ultrasonographic protocols have been created to evaluate patients with shock, however, none of these include the importance of evaluating for hydronephrosis. This case series highlights the importance of renal ultrasound in patients with undifferentiated septic shock.</p>