A 49 year-old woman with acute pulmonary thromboembolism and severe hemodynamic impairment was successfully treated with tissue-type plasminogen activator (r-TPA). She did not have previous pulmonary or cardiac diseases. Thirty days after immobilization of the right ankle, she had a sudden onset of dyspnea, epigastrial pain and syncope. As heparin therapy was unsuccessful, 90 mg of IV r-TPA was administered. There was rapid clinical and hemodynamic improvement of her condition. Pulmonary scanning one week later was normal and she was discharged without symptoms 12 days after the acute episode.