The case of a 65 years old lady, diabetic, hypertensive, reduced functional class with history of episodic dyspnoea lasting for few weeks for the last two years. On presentation she was tachypnoiec with reduced oxygen saturation. Jugular venous distension was present with bibasal crackles. Her ECG was normal. Echocardiogram revealed, dilated right sided chambers with right ventricular systolic dysfunction and severe pulmonary hypertension. A CT chest was performed which showed multiple thrombi in the main and branch pulmonary arteries establishing the diagnosis of chronic thromboembolic pulmonary hypertension.