For example, in our ICU, we recently had a case that perfectly illustrates the value of bedside echocardiography in the management of patients with shock. A 59-year-old woman with a medical history of multiple sclerosis with paraplegia and depression was admitted in a psychiatric center after trying to commit suicide. Five days after admission, fever led to the diagnosis of urinary tract infection with left-sided back pain, a high leukocyte count, and Escherichia coli in a urine culture. She was then transferred to the ICU with a diagnosis of shock (eg, marbling, mean arterial pressure of 44 mm Hg, heart rate of 150/min). Multiple organ failure rapidly developed, with the need for mechanical ventilation, fluid loading, norepinephrine infusion (1.5μ/kg/m), and renal replacement therapy. Laboratory examination showed a high leukocyte count (21,000/mm3), lactic acidosis (pH 7.10, arterial lactate 6.4 mmol/L), acute renal failure (anuria), and mild hypoxemia (Pao2/Fio2 = 300). Hepatic and pancreatic tests were normal. An abdominal CT scan showed diffuse colitis with no sign of perforation and lack of kidney abnormality. The diagnosis of septic shock was suggested, and wide spectrum antibiotics were initiated. Upon hemodynamic optimization, transesophageal echocardiography was performed to assess cardiac function because of the patient’s unstable state, with persistent lactacidemia despite fluids and vasopressors. An unexpected image of acute core pulmonale was found, with right ventricular dilation, a paradoxical interventricular septal motion pattern, and no respiratory variation of the superior vena cava diameter with a massive mobile thrombus in the right atrium (Fig 1 and online video supplement), confirming the diagnosis of massive pulmonary embolism. Extension of the thrombus to the right pulmonary artery was seen. Thrombolysis was subsequently implemented, leading to a decrease in vasopressors and the disappearance of thrombus from the right atrium on the follow-up by echocardiography.