Management of postoperative acute massive pulmonary embolism (PE) presents a dilemma because recent surgical procedure is usually considered an absolute contraindication for thrombolysis. In these patients, catheter or surgical embolectomy are helpful for rapidly reversing right ventricular failure. However, pulmonary embolectomy itself has a high mortality and may not always be available. We report the successful use of low-dose intra-embolic thrombolysis for acute massive PE after abdominal total hysterectomy. The infusion of low-dose urokinase produced an immediate improvement in the patient's hemodynamic state. The patient tolerated the thrombolytic therapy well, without hemorrhage or other complications and made a successful recovery.