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Pulmonary embolism is an uncommon but potentially serious etiology of chest pain and a clinical scenario in which diagnostic testing is often used to stratify risk. In the pediatric population, pulmonary embolism in patients without a prior episode of thrombosis presents infrequently (1 in 50,000 pediatric ED visits) and many of these patients do not have chest pain as their chief complaint. In the previously healthy adolescent who presents for the first time with chest pain concerning for pulmonary embolism, there is evidence that algorithms extrapolated from research in adults, plus the use of D-dimer levels, can aid in the decision of whether to perform a chest CT scan. Use of the Pulmonary Embolism Rule-out Criteria (PERC) rule in a child for whom the probability of a pulmonary embolism is thought to be below 15% is a reasonable way to exclude the diagnosis without additional testing. Most pulmonary embolisms in the pediatric population occur in those with risk factors such as malignancy, thrombophilic disorder, use of hormonal contraception, or pregnancy.