Pulmonary embolism can occur in various situations and it can result in severe hemodynamic instability, including cardiac arrest. Because of its fatality, diagnosis and treatment should be immediate and proper. We report a case of pulmonary embolism just after combined spinal epidural anesthesia. We diagnosed pulmonary embolism by echocardiogram, spiral CT and pulmonary angiography. Besides immediate use of heparin, tissue plasminogen activator therapy was started with 10 mg bolus and 90 mg intravenous infusion during 2 hours. Despite the therapy, pulmonary embolism was not resolved and the patient was expired.