apart from use in operative cases and cardiac laboratories , transesophageal echocardiography ( tee ) in now being increasingly used in critical care units . the complications with its use are primarily related to gastrointestinal , cardiovascular , and respiratory systems along with some miscellaneous problems related to probe insertion , drugs , and inexperience of the operator . our case report does not describe a complication due to tee per se , but a unique clinical situation , which has not been reported previously . a 55-year - old male , with chronic liver disease , long - standing diabetes mellitus , and obesity ( body mass index of 30 ) , was admitted to the intensive care unit ( icu ) with altered sensorium , upper gastrointestinal bleed , and hemodynamic instability . his hemoglobin was stabilized to 12 g% after transfusion of packed red blood cells . despite control of bleed , he developed a temperature of 39c ( axillary temperature ) with circulatory shock and increasing lactate levels . his 24 h culture ( blood , urine , and mini bronchoalveolar lavage ) reports sent on icu admission were sterile . his bedside echocardiogram showed a very poor window with a provisionally normal report . in view of long - standing diabetes mellitus , obesity , and poor transthoracic images , a bedside tee was planned to rule out a cardiac cause of poor hemodynamics . after appropriate consent , the transesophageal probe ( mylab 30gold esaote , te 022 ) was inserted orally into the esophagus . it was examined physically for any defects before insertion . within seconds of the probe insertion , the examination was withheld and a cold saline lavage was given through the nasogastric tube to reduce the local temperature . the lavage reduced the local temperature down to 38c after which examination was resumed . after obtaining images for 5 min , there was a rise in temperature and the above procedure was repeated twice before we could satisfactorily complete the examination . esophageal heating and potential injury can occur from piezoelectric crystal vibration within the transesophageal probe tip or by direct tissue heating from absorbed ultrasound energy . esophageal thermal injury has been reported in patients with severe atherosclerotic cardiovascular disease in whom the esophageal circulation was presumed to be compromised . therefore , tee probes have a thermocouple to monitor transducer tip temperature and an automatic shutdown mechanism when a critical preset temperature ( 42 - 46c ) has been reached . tee has been described in literature in patients with fever , most commonly in suspected bacterial endocarditis . the manufacturer guide does mention that the thermal limit can be reached in patients with fever . however to our knowledge , this is the first case report describing shutdown of the probe due to increased body temperature of the patient . in our patient , the probe stopped functioning immediately on entering the esophagus in the presence of high temperature and resumed functioning after a cold saline lavage . the stomach lies in close proximity to the liver and inferior vena cava , gastric lavage is a reasonable method to rapidly cool hyperthermic patients . a core temperature reduction of approximately 0.15c / min can be achieved using this method . we could complete our examination because of intermittent cold saline lavages which were given through the nasogastric tube . it would have been ideal if we had anticipated such a problem before probe insertion . active measures would have reduced the body temperature , and we could have completed our examination within a shorter period of time . we would recommend that tee in a critically ill patient with fever should consider such a possibility and appropriate preventive measures should be taken . future attempts should be made for refinement of probe technology so that the machine is able to differentiate in temperature rise within the probe versus the surroundings .