Pulmonary embolism (PE) occurs when a clot blocks a pulmonary artery. The condition is potentially life-threatening. Identifying patients at risk allows early interventions to reduce mortality. Symptoms and signs are nonspecific and underdiagnosed. this study is aimed at assessing the clinical patterns of presentations and risk factors of acute PE. A cross-sectional hospital-based study was done in Alshaab Teaching Hospital from May to December 2019. Data was analyzed using SPSS. Clinical presentations seen in decreasing frequency included: dyspnea of gradual onset at 34.4 %, pleuritic chest pain at 29.5 %, cough at 27.9 %, hemoptysis at 14.8%, and lower limb swelling at 11.5%. The post-surgical intervention was the highest risk factor 27.9 % especially orthopedics surgery, followed by the post-delivery period and respiratory disease 14.8 %. Computer tomography scan was the most often used method to confirm the diagnosis and low molecular weight heparin was the main treatment used. The study concluded that the presence of multiple risk factors is common in acute PE. Symptoms may be mild and maintenance of a high level of suspicion is essential. The highest prevalence was between 41-60 years. Mostly seen among females, the Method of diagnosis is used in clinical probability and CTPA, trans thoracic Echocardiography, and Doppler ultrasound in the presence of obvious limb swelling. Therapeutic measures were according to the guidelines. Most were discharged and arranged for outpatient follow-up. early presentation can decreases morbidity and mortality and improves outcomes, to offer high-risk groups prophylactic measures and better quantification of risk factors.