We compared patient treatment with imaging strategy in patients with clinically suspected pulmonary embolism (PE) and intermediate-probability lung scans (IPLS). We retrospectively reviewed the medical records of 214 consecutive patients with clinically suspected PE with IPLS. Treatment (full anticoagulation, filter placement, or both) was given in 66 (31%) of 214 patients. Only 37% of patients were treated on the basis of definitive diagnostic imaging results. Most patients (134 [63%] of 214) were treated without an imaging diagnosis: 30 (14%) of 214 patients were treated for acute PE on clinical grounds, and the diagnosis of PE was not excluded in 104 (49%) of 214 patients. Most patients with IPLS are treated without a definitive imaging diagnosis. This lack of diagnosis may result in the overtreatment of patients who do not have acute PE or, more importantly, in the undertreatment of patients who do have acute PE. Further studies are necessary to evaluate the impact of the current management strategies on patient outcome.