CASE PRESENTATION: 48-year-old male frequent flyer to Peru with a recent history of a bleeding gastric ulcer presented with dyspnea. The patient was hemodynamically stable, with BP of 122/75mmHg, HR of 83 bpm. He was breathing 19 bpm with room air oxygen saturation of 97%. Initial troponin was 0.03ng/ml & BNP was 63pg/ml. A Chest CT angio showed an acute PE extending across the right and left main pulmonary arteries into lobar branches with signs of RV strain(Fig.1A). Pulmonary team performed POCUS which showed a large free floating RHT(Fig.1B) and bilateral deep vein thrombus(DVT). PERT was activated and the patient was seen by intensivists, cardiologists, interventional radiologists and cardiothoracic surgeons. TEE showed RHT with a patent foramen ovale(PFO)(Fig.1C). After interdisciplinary discussion, the patient received open pulmonary embolectomy(Fig.1D) with PFO closure and retrievable IVC filter placement. The patient was discharged after 8 days of hospitalization on therapeutic anticoagulation.