A 59-year-old man presented with cardiogenic shock caused by acute right ventricular failure due to extrinsic compression of the right coronary artery by a thoracic aorta pseudoaneurysm. Angiography and real-time 3D transoesophageal echocardiography (TEE) were performed and enough diagnostic accuracy was achieved to operate on the patient without further image techniques and consequent delay. Three-dimensional TEE is a new technology that combines high-quality anatomic and colour Doppler information with bedside performance, essential in emergent clinical scenarios.