Pulmonary embolism (PE) is a potentially fatal entity that is frequently diagnosed in the emergency department (ED). Emergency physicians (EPs) routinely perform focused cardiac ultrasound (FOCUS) to support a prompt ED diagnosis of PE. Direct visualization of a right heart thrombus (RHTh) with FOCUS is diagnostic of PE.

However, this is rarely encountered in the ED, with the prevalence of RHTh reported to be as low as 4% among PE patients.

The coexistence of a RHTh with PE carries an increased mortality risk necessitating aggressive management.

Previous reports have described the crucial role of EP-performed FOCUS to establish the diagnosis of RHTh.

We report a case in which EP-performed FOCUS facilitated the expeditious diagnosis and management of RHTh in transit associated with submassive PE.

A RHTh in transit coexisting with a PE is a disease process that is often fatal if not recognized. FOCUS performed early during the ED encounter can facilitate EPs to make this diagnosis definitively and initiate timely treatment. Outcomes-based research of EP-performed FOCUS combined with newer therapeutic strategies for submassive PE (with and without the presence of RHTh) warrant further investigation.

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