Pulmonary embolism is usually caused by blood clots that travel to the lungs from the legs or other parts and me life-threatening. More rarely, pulmonary vascular obstruction may be due to a tumor. We report the case of a 68-year old man who presented with symptoms and signs suggesting high-risk acute pulmonary embolism. The computed tomography pulmonary angiography initially confirmed the diagnosis showing filling defects within the pulmonary vasculature. Fibrinolysis treatment allowed hemodynamic restoration.

Unfortunately, one month later, the patient presented with cardiogenic shock due to acute pulmonary obstruction. A rescue embolectomy was decided and the surgeon discovered a tumor instead of a clot. Anatomopathology confirmed an unusual pulmonary artery leiomyosarcoma not initially suspected.