Although initial therapy for PE is primarily aimed at life-saving restoration of flow through occluded pulmonary arteries, thrombolytic therapy, anticoagulant therapy, or surgery is the main treatment options for high-risk PE. Among these options, thrombolytic therapy carries a significant risk of bleeding, especially
when predisposing conditions or comorbidities exist, with randomized trials reporting a 13% cumulative rate of major bleeding and a 1.8% rate of intracranial/fatal hemorrhage with thrombolytic therapy [1]. Fortunately, massive spontaneous hemothorax following combined thrombolytic and anticoagulant therapy for PE is very rare, and
very few cases have been reported to date. Here, we present 1 such rare case of spontaneous hemothorax after thrombolytic and anticoagulant therapy for massive PE.