To our knowledge, only four reports have previously described endobronchial thrombolysis with streptokinase for airway obstruction due to blood clots; the highest dose used was 80,000 U. Herein we describe a 21-year-old woman with pulmonary embolism who experienced life-threatening airway obstruction due to a large blood clot in the distal trachea. Streptokinase (120,000 U), injected through a fiberoptic bronchoscope, partially dissolved the clot. The rest of the clot was removed easily with forceps and suctioning. No complications occurred.