The diagnosis and treatment of acute pulmonary thromboembolism (PE) remains a complex clinical challenge. Many studies have used both transthoracic and transesophageal echocardiography as a diagnostic and/or prognostic tool in this common disorder. In patients with central, hemodynamically significant PE, echocardiography can directly visualize thrombus or demonstrate the hemodynamic consequences of PE, whereas in the majority of patients, the sensitivity of echocardiography appears limited. Echocardiography may be useful in assessing the prognosis of patients with PE as well as their response to therapy. Further studies are needed in larger populations of patients to clarify the role of echocardiography in the assessment of patients with clinically suspected PE.