Pulmonary embolism (PE) is difficult to diagnose clinically. In a patient who was scheduled for elective aortic valve replacement, several fresh emboli were recognized in the right atrium on transesophageal echocardiography (TEE). The PEs then disappeared on the echocardiographic image, with significant immediate hemodynamic changes noted by real-time monitors, such as tachycardia and increased pulmonary artery (PA) pressure. Pulmonary embolism was highly suspected. After cardiopulmonary bypass and aortic valve replacement, PA thromboembolectomy was performed successfully. The patient survived and was discharged from the hospital 17 days later without sequelae.
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