The diagnosis of pulmonary embolism (PE) is challenging because the symptoms are unspecific and an objective confirmation of the disease is required. Clinical symptoms and physical examination can be used to estimate the clinical probability of the disease used to interpret the results of the diagnostic tests. In patients with low or moderate clinical probability most quantitative D-dimer tests allow to exclude PE safely. A positive proximal venous ultrasound enables to confirm PE but the sensitivity is too low to exclude the diagnosis. In patients with a positive D-dimer test, multidetector spiral CT allows to confirm or exclude PE with confidence in most of the cases. Lung scanning is still useful in patients with renal impairment or allergy to contrast medium.