Key PointsQuestionAre concerning computed tomography findings among patients seen in the emergency department with acute, low-risk pulmonary embolism (PE) (eg, saddle PE, right ventricular strain, pulmonary infarct) associated with differences in treatment and/or clinical outcomes?FindingsIn this cohort study of 817 patients, concerning computed tomography findings were associated with increased hospitalization and resource utilization but not short-term adverse clinical outcomes.MeaningThese findings suggest that concerning computed tomography imaging findings may be a significant barrier to outpatient treatment among patients with otherwise low-risk acute PE.