Background <p>In this study, we examined the potential role of V/Q scintigraphy in distinguishing acute PE (APE) from chronic PE (CPE).</p> Materials and methods <p>From 2020 to 2023, 36 patients diagnosed with APE&#xa0;and 24 patients diagnosed with CPE were included in the study. Location (segmental, subsegmental, lobar), number and appearance (wedge/patch) of mismatch perfusion defects on V/Q scintigraphy were recorded, and data were compared between the two groups.</p> Results <p>The number of mismatch segmental defects on V/Q scintigraphy was higher in the APE group (p = 0.042). The number of wedge-shaped defects was higher in the APE group (p = 0.003), while patchy defects were more common in the CPE group (p &lt; 0.001). A negative correlation (p = 0.002) was observed between CPE and the number of wedges, whereas a positive correlation (p&#xa0;&lt; 0.001) was found between CPE and the number of patches. Pulse oxygen saturation negatively correlated with the number of patches (p = 0.012). A negative correlation also existed between the number of mismatch segmental defects and CPE (p = 0.041). APE was indicated when the number of wedges was ≥1.5 (75% sensitivity,62% specificity,&#xa0;p = 0.03), while CPE was indicated when the number of patches was ≥0.5 (88% sensitivity,&#xa0;61% specificity,&#xa0;p &lt; 0.001). Patchy defects were found to be an independent risk factor for CPE (p = 0.008, OR: 2.1, 95% CI: 1.2-3.7).</p> Conclusion <p>Patchy defects serve as an independent risk factor for CPE and correlate with the severity of hypoxemia.</p>