the causes of pulmonary embolism can be venous thromboembolism , and nonthrombotic embolism like septic , fat , air , amniotic fluid and tumour embolism . tumour embolism to lungs can arise from cancers of breast , stomach , liver , kidney and rarely from choriocarcinoma . choriocarcinoma is a malignant , trophoblastic cancer , belonging to the malignant end of the spectrum in gestational trophoblastic disease , which can occur following molar pregnancy , ectopic pregnancy , abortion and even normal pregnancy [ 2 , 3 ] . choriocarcinomas spread via blood and lymphatics with early haematogenous spread to lungs , resulting in pulmonary embolism , pulmonary oedema , pulmonary hypertension or acute respiratory distress syndrome . in a young female presenting with persistent shortness of breath , cough and chest pain , the possibility of metastatic pulmonary embolism should be considered as surgery and chemotherapy can cure the choriocarcinoma metastasizing to the lungs . a 25-year - old lady was admitted in the pulmonology ward with the diagnosis of pneumonia . the patient had presented with a history of progressive shortness of breath , chest pain and persistent cough with occasional haemoptysis . she had a history of being treated with antibiotics and anti - tb drugs in outpatient basis . since her symptoms were persistent and her general condition was deteriorating , she was admitted to the ward . on examination , she had crepitations in bilateral chest and an oxygen saturation of only 80% . cect chest was done , which revealed pulmonary embolus occluding the main pulmonary artery , and right and left pulmonary arteries ( fig .  1 ) . serum beta - human chorionic gonadotrophin ( hcg ) level was found to be significantly high . she was managed further with chemotherapy ( emaco regimen ) with excellent response to the treatment . figure  3:histopathological image showing the trophoblastic elements . a ct scan image showing thrombus in the pulmonary artery . women in the reproductive age group with lung metastasis present with dyspnoea , chest pain , cough and haemoptysis . as the diagnosis can always be misleading and patient might be treated in the line of pneumonia or tuberculosis , it is very essential to have a high index of suspicion . surgery is indicated in patients with haemodynamic instability and those with massive tumour burden occluding main pulmonary and branch pulmonary arteries . so , chemotherapy should be initiated as soon as the diagnosis is strongly suspected or confirmed . pulmonary embolism due to choriocarcinoma should always be suspected in a reproductive age woman presenting with intractable shortness of breath .