Key Clinical message BLUE protocol provides excellent step by step approach for diagnosis of acute dyspnea. Adding FECHO to BLUE protocol complete the picture and help making solid diagnosis especially in sub-massive and massive PE. COVID-19 infection can present with thrombotic manifestations like DVT and PE with no ultrasonographic evidence of lung parenchymal affection. Abstract Acute Dyspnoea is one of the most distressing complains for the patients and challenging diagnosis for the physicians. In many cases Physical examination and chest x ray alone not helpful in diagnosis. Lung ultrasonography is becoming a standard tool in critical care medicine. Blue Protocol of ultrasound lung is very beneficial, easy to be applied and help to save time that can be consumed in doing sophisticated investigations like Computerized tomography examination of the chest. Anterior lung sliding is checked first. Its presence exclude pneumothorax. The B profile (Anterior bilateral B-lines associated with lung sliding) suggests pulmonary oedema. The A profile (Anterior bilateral A-lines associated with lung sliding) prompts a search for venous thrombosis. The presence of lung A profile plus Venous thrombosis (figure 3), Make pulmonary Embolism as a cause of acute dyspnoea on the top of the diagnosis list. Extending the Blue protocol of lung ultrasound by adding Focused cardiac ultrasound (FECHO) can confirm diagnosis of pulmonary embolism in this situation especially in the presence of acute right ventricular strain pattern (figure 4), pulmonary hypertension and positive McConnell’s sign (figure 5). In the current Coronavirus disease 2019 (COVID-19) pandemic, A lot of atypical presentations especially thrombotic manifestations is there. We present a case of acute dyspnoea with history of fever diagnosed by Blue protocol ultrasonography plus FOCUS as a case of lower limb thrombosis and acute pulmonary Embolism with no ultrasonographic evidence of lung parenchymal affection. With the help of modified BLUE protocol, we diagnose DVT and massive pulmonary Embolism as manifestation of COVID-19, which was confirmed later with positive nasopharyngeal swab.