Rodríguez Núñez, NuriaVirgós-Pedreira, AlejandraIllade-Fornos, AlfonsoFerreiro Fernández, LucíaToubes Navarro, María ElenaValdés Cuadrado, Luis2026-02-062026-02-062025-02-11Rodríguez-Núñez, N., Virgós-Pedreira, A., Illade-Fornos, A., Ferreiro- Fernández, L., Toubes-Navarro, M. E., & Valdés-Cuadrado, L. (2025). Importance of the Study of the Right Heart Chambers in Symptomatic Acute Pulmonary Embolism. Respirology Case Reports, 13(2). https://doi.org/10.1002/RCR2.70098https://hdl.handle.net/10347/45714We present the case of a 42-year-old woman on oral contraceptives that presented to the emergency department with pain and swelling in the left lower limb. Diagnosis of extensive deep vein thrombosis was established. A few minutes later, she exhibited signs of shock and hemodynamic instability, thus raising suspicion of high-risk acute pulmonary thromboembolism. Prior to the administration of fibrinolytic treatment, a bedside transthoracic echocardiography was performed that excluded right ventricular dilatation. Then, the study was complemented with a thoraco-abdominal computed tomography scan that demonstrated a large retroperitoneal hematoma as the cause of the shock. In conclusion, a transthoracic echocardiography should be performed before initiating thrombolytic therapy in hemodynamically instable patients with strong suspicion of high-risk pulmonary embolism.eng© 2025 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.Attribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/Hemodynamic instabilityPulmonary embolismTransthoracic echocardiographyjournal article2025-12-1210.1002/RCR2.700982051-3380open access2051-3380