Introduction: Unexpected cardiopulmonary complications are a well-known and feared entity during surgery and anaesthesia, acknowledged in previous reports. Focus Assessed Transthoracic Echocardiography (FATE) has proven to be feasible in intensive care units and perioperatively for evaluation of cardiopulmonary function by visualisation of the heart and pleura. The aim of this study was to determine the frequency of unexpected cardio-pulmonary pathology by FATE in unselected patients scheduled for acute surgery. Patients and methods: Patients scheduled for acute orthopaedic or abdominal surgery on predefined study days were included. Age and American Society of Anesthesiologists (ASA) physical status classification was registered. Before induction of anaesthesia, all patients underwent FATE examination at the bedside. Interpretation of the images was performed immediately and pathological findings were recorded. After the routine preoperative assessment these were reported to the anaesthetist responsible for the anaesthesia.Whether or not this led to changes in the perioperative management was registered. Results: 112 patients scheduled for acute surgery were included. Mean age was 62 years (57.7-65.6). 24% of patients were in ASA group 1, 39 % were in ASA group 2, 32% were in ASA group 3 and 4 % were in ASA group 4. FATE was feasible with images suitable for interpretation in all patients. Unexpected pathology was found in 27 % of patients and this led to a change in management in 43% of the patients with unexpected pathology. All findings that lead to a change in management occurred in patients above the age of 60 and/or in ASA group 3. Conclusion: In an unselected population of patients scheduled for acute surgery, we found a high number of patients with unexpected pathology by FATE leading to significant changes in management. The results call for studies on patient related outcomes measures in relation to FATE in the preoperative assessment. This study identifies a potential high-risk group.