The Pulmonary embolism (PE) incidence is higher in patients with chronic kidney disease and renal transplantation (RT) than in general population. Thrombotic events are multifactorial in renal transplantation recipients and hypercoagulability is the most common factor. We present a case of a 67-yearold renal transplant patient with acute, large thrombus in pulmonary arteries and right heart cavities treated successfully with thrombolytic with low dosage in low infusion protocol.