A 67-year-old patient was sent to the internal medicine consultation due to dyspnea, orthopnea and lower limb edemas for 6 month, which got worse in the past 2 weeks, with diffi cult stabilization and control, even with intense therapy for heart failure. The therapy was improved and an echocardiogram was requested. One month later she was reevaluated showing no clinical improvement, so she was admitted in the internal medicine ward. The echocardiogram showed an ejection fraction of 21%, increased right chambers, severe pulmonary hypertension and left ventricle dilatation with depressed cardiac function. The therapy for heart failure was optimized and a ventilation-perfusion scyntigraphy was performed to evaluate the respiratory system. It revealed areas of pulmonary collapse and pulmonary embolism. On the ward she suffered a sudden episode of dyspnea and left leg edema and experienced severe pain. An ultrasound of the lower limbs proved the existence of bilateral severe deep venous thrombosis. For a further investigation the patient did a body CT-scan and cancer markers were searched. The CA19.9 was 253679 and there were several metastatic lesions on the liver and an infracentrimetic mass on the pancreatic tail on the CTScan. She started anticoagulation for prevention of other pulmonary embolism, while waiting for a pancreatic biopsy. The patient died 3 month after the diagnosis due to a sudden Myocardial infarction. The symptoms of heart failure dominated the whole clinical picture, being the DVT the wind of change to establish the diagnosis of pancreatic cancer, a scary disease that was silent for so long. This case shows the importance of the paraneoplastic symptoms such the bilateral DVT which was the important milestone for a further investigation and the fi nal diagnose.