A case of a 44-year-old male with massive pulmonary embolism is presented. Due to recent intra-cranial haemorrhage and on-going urinary bleeding, the patient was not treated with anticoagulant or thrombolytic agents. Because of the symptoms of cardiogenic shock, an urgent surgical pulmonary embolectomy was performed, using an approach firstly described by Trendelenburg in 1908. The procedure was performed without a cardio-pulmonary by-pass which was contra-indicted in this patient. During surgery, a massive thrombus from both right and left pulmonary arteries was removed. The patient survived surgery and seven days later was transferred to another hospital where the rehabilitation process was successfully continued.