Echocardiography has been used to diagnose acute right-sided dysfunction arising from pulmonary embolism (PE). Rarely, it can visualize the embolic material in the right heart cavities. We report a case of acute PE that was seen in the right ventricle and right pulmonary artery using bedside transthoracic echocardiography in the ED. As a result of the prompt diagnosis of a massive embolus and associated right ventricular dysfunction, the patient was treated with thrombolytics. Serial echocardiographs confirmed the response to therapy and the dissolution of thrombi. In this report, echocardiographic findings of acute PE and indications of thrombolytics in PE are also reviewed from the literature. Based on available evidence, those patients who present with cardiogenic shock from PE, and young patients with acute PE leading to right ventricular dysfunction benefit the most from early thrombolytic therapy.