Pulmonary thromboembolism is one of the leading causes of morbidity and mortality globally, with an incidence of approximately 600,000 cases and nearly 180,000 deaths. It is common in cancer patients, associated with various factors such as procoagulant agents secreted by tumor cells, immobilization, and surgery.

To present the case of a man with colon cancer and acute pulmonary thromboembolism resolved with ultrasound-guided low-dose fibrinolysis by endovascular catheter.

A 71-year-old man was diagnosed with type 2 diabetes Mellitus and moderately differentiated sigmoid adenocarcinoma ten days before the sigmoidectomy operation, suddenly presents with dyspnea at rest, tachycardia, diaphoresis, and tachypnea. Troponin I: 0.16, Pro-BNP: 19306. Angiotomography of the pulmonary arteries was performed with evidence of an endoluminal defect in the right and left pulmonary arteries.

Transthoracic echocardiogram shows mild diastolic dysfunction, ejection fraction 62%, TAPSE 19mm, and paradoxical movement of the septum.

Due to the history of cancer and PTE with hemodynamic instability, thrombus aspiration, in situ thrombolysis, and placement of an EKOS probe were decided. In the left segmental branch, thrombus-aspiration was performed with a PRONTO catheter on ten occasions. In the right segmental branch, thromboaspiration was performed more than ten times; mechanical thrombolysis was performed with a 5 FR Pig Tail catheter, then an EKOS probe was placed in this branch, with an infusion of ACTYLISE at a dose of 1mg/hr. Adequate functioning is corroborated, it is possible to obtain clots from both pulmonary branches, and better permeability of both branches is observed in control angiography; the procedure is terminated without complications.

Interventional therapy is an option for patients to improve their prognosis, and it has been shown that PSAP levels and RV function improve in the long term; The resolution of this complex and dynamic pathology is a challenge for the pulmonologist, the clinical cardiologist, and the interventionist. However, little by little, we have a larger Arsenal to combat it and try to minimize the damage (Fig. 1, Fig. 2, Fig. 3, Fig. 4).