Background and Objectives: Chest computed tomography (CT) is the first-line pulmonary embolism imaging test and gives information about the cardiac morphology. We hypothesized that chest CT to diagnose the pulmonary embolism can give rapid approach to the RV dysfunction and have a prognostic value for the occurrence of adverse outcomes. Materials and Methods: We reviewed 121 patients diagnosed as acute pulmonary embolism by chest CT. Seventy seven patients underwent echocardiography within the ensuing 7 days. We defined adverse clinical outcomes as at least one of following: death associated embolism in 30 days, cardiopulmonary resuscitation, use of inotropics due to hypotension, mechanical ventilation, and thrombolysis or surgical embolectomy. Chest CT was reviewed and RV to left ventricle (LV) diameter ratio (RVd/LVd), presence of septal bowing toward LV and location of embolus were evaluated. We compared CT findings with RV hypokinesia on echocardiography and with adverse clinical outcomes. Results: RV hypokinesia on echocardiography was present in 35% (24/77) of patients. RVd/LVd (p<0.001), septal bowing (p<0.001) and proximal location of embolus (p=0.014) on CT were significantly associated with RV hypokinesia. The odds ratio (OR) of RVd/LVd >1 by CT for adverse clinical outcomes was 22.4 (p<0.001). The OR of RV hypokinesia on echocardiography was 8.2 (p<0.001). Presence of all three CT parameters (RVd/LVd >1, septal bowing, and proximal location of pulmonary embolus) predicted adverse clinical outcomes (positive predictive value 61.1%, negative predictive value 90.6%, sensitivity 73.3%, specificity 84.6%, and OR 15.1). Conclusions: CT parameters were well correlated with RV dysfunction and associated with poor outcomes in acute pulmonary embolism. Rapid risk stratification of pulmonary embolism patients may be possible based on chest CT.