Abstract: With the high incidence of active tuberculosis combined with pulmonary embolism, diversified clinical manifestations and high mortality rate, early detection and treatment are particularly important for the prognosis of patients. This paper reports a young male patient who was admitted to the hospital due to abdominal distension and wheezing. Previous physical health, and no underlying disease. The initial diagnosis of tuberculosis was combined with multiple serosal fluid effusion, chronic heart failure. After anti-tuberculosis and corrected heart failure, the symptoms were not relieved and the condition was gradually aggravated. After further examination, it was found with deep vein thrombosis and pulmonary embolism of both lower limbs. The clinical diagnosis was severe tuberculosis with pulmonary embolism, and after the addition of anticoagulant drugs such as edoxaban, the patient's symptoms were significantly relieved, and the thoracic and abdominal fluid absorption was improved and discharged from hospital. Through this case, this paper discusses the clinical characteristics, imaging manifestations of severe tuberculosis combined with pulmonary embolism, and the active and effective comprehensive treatment methods, and discusses the relevant literature review, aiming to improve the vigilance of clinicians, reduce the rate of missed diagnosis, improve the diagnosis and treatment level of severe tuberculosis combined with pulmonary embolism, and reduce the risk of death.

Key words: Pulmonary embolism, Severe tuberculosis, Tuberculous polyserous effusion, Anti-tuberculosis, Anti-coagulation