The diagnosis of pulmonary embolism (PE) is not based on a single and definitive test but on the application of an integrated diagnostic strategy in which lung scintigraphy plays an important role. Performance and utility of lung scintigraphy in the evaluation of acute and chronic PE are reviewed in this chapter. The scintigraphic diagnosis of PE is unique in that it depends on contrasting two separate physiologic processes, ventilation (V) and perfusion (Q), within the lungs. V/Q scintigraphy has an especially important role to play in diagnosing acute PE in patients who cannot tolerate iodinated contrast material and in young female patients, because of a more favorable radiation exposure to the breast as compared to computed tomography pulmonary angiography (CTPA). Technical details of the examination, including radiopharmaceuticals administered, imaging modalities, and criteria of interpretation, are discussed with an emphasis on currently performed methods, including both planar and tomographic techniques of imaging, each favored in different geographical regions. The application of lung scintigraphy in special circumstances, such as pregnancy and suspected respiratory infection, is discussed. Scintigraphy plays a critical role in evaluating chronic sequelae of PE, including residual pulmonary vascular occlusion (RPVO) and chronic thromboembolic pulmonary hypertension (CTEPH), by virtue of its sensitive functional nature. Future oriented concepts such as positron-emission tomography (PET) imaging and application of artificial intelligence (AI) in PE are briefly referenced.