TEE (midesophageal 4-chamber view of the RV) in a patient with a pulmonary embolus

In this 4-chamber view focused on the right ventricle we see a dilated right atrium and ventricle with RV akinesia with apical sparing, and left ventricular hyperkinesis and underfilling. These findings are consistent with a pulmonary embolus. There is septal shift leftward suggesting right ventricular pressure and volume overload. There is also an echogenic mass in the right ventricle consistent with embolic material. While it is not common to see the embolic material in transit, the other findings shown here are classic for pulmonary embolus.