Massive intraoperative pulmonary embolism (PE) is a fatal complication. However, the diagnosis of PE is difficult because clinical symptoms and signs are nonspecific, and specialized diagnostic facilities are not readily available in the operating room. We report a case of cardiac arrest due to a massive PE diagnosed by transthoracic and transesophageal Echocardiography during a nephrectomy in patient with renal cancer. This case demonstrates the great value of echocardiography in the diagnosis of an intraoperative massive pulmonary embolism.