Background: Pulmonary embolism (PE) is a common disease and a frequent cause of death. It is responsible for 10% of in hospital mortality, medical and surgical. We assessed the value of combining clinical probability, measured plasma D-dimer and echocardiographic criteria to diagnose PE.Methods: In 20 patients (7 males and 13 females) who were diabetic, poly-traumalized, stroked, on contraceptive pills, having malignancies or autoimmune diseases, and diagnosed provisionally as PE according to history and clinical setting, we collected the clinical, laboratory (routin, ABGs and plasma D-dimer), electrocardiographic echocardiographic and first-pass radionuclide angiographic data prior to pulmonary angiography that was done to all studied patients. Catheter guided intrapulmonary thrombolysis (CGIPT) was considered in selected patients.Results: Pulmonary angiography proved the diagnosis in 8 patients (group I) and excluded the diagnosis in 12 patients (group II). All studied pts were Dyspnic, Tachycardic and Tachypnic; Hypoxia, RVD, First pass radionuclide angiography showed statistically significant deferens between the 2 groups. Five patients received CGIPT with subjective and objective improvement in four patients. Conclusion: Emergency diagnostic pulmonary angiography is recommended in suggestive clinical settings of pulmonary embolism, especially in the presence of dyspnea, tachycardia, tachypnea, hypoxia, right ventricular dilatation and impaired right ventricular ejection fraction in the presence of positive plasma D-dimer. Further prospective studies are needed to justify the superiority of catheter guided intrapulmonary thrombolysis over systemic thrombolysis with its potential hazards.