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Severe Pulmonary Embolism: Should thrombolysis be performed with high clinical probability and where echocardiography is unable to be practiced? Background: Severe pulmonary embolism is considered as an urgent indication of intravenous thrombolysis. Case presentation: Here we describe the case of an obese female patient of 34-year-old in the emergency unit, she had a typical clinical picture and recent history context that were very strongly suspicious of a serious pulmonary embolism, so the patient had undergone a successful intravenous thrombolysis (Quick and obvious recovery of the respiratory state) despite the fact that neither an echo-heart nor a Computed tomography angiography were able to be realized because patient transportation was impossible. Discussion/Conclusion: In this case, the situation (when major complementary exams are unavailable or impossible to perform) adds more difficulties but such a heavy decision of acting thrombolysis or no remains possible. The right appreciation of the clinical context and surrounding factors could lead us to an accurate diagnosis. Computed tomography, Echo-heart, arterial Gasometer, remain major advancements of today’s medicine and should not be ignored if available. Thrombolysis should be done with extra-carefulness and with a very fine evaluation of contraindications.

Severe Pulmonary Embolism: Should Thrombolysis be Performed if the Clinical Probability is High Enough without an Echo-Heart?