We present a 45-year-old man with a personal pathological history of deep vein thrombosis of the lower limbs without current medical management. It begins suddenly with respiratory difficulty, decreased oxygen saturation, and dyspnea. Upon arrival at the emergency department, chest angio tomography was performed, highlighting bilateral filling defects, from main branches to segmental branches, so admission to the hemodynamics room for right heart catheterization was decided. Thrombectomy, bilateral ultrasound rheolysis and targeted fibrinolysis were performed, with improvement in mean pulmonary artery pressure (mPAP) to 19 mmHg compared to the previous one.