Mortality associated with pulmonary embolism can be reduced significantly by timely diagnosis, leading to early and prompt treatment. History and physical examination findings are often nonspecific in patients with pulmonary embolism , but in developing country ,there are most reliable in diagnosis complemented with Well's score with having limited diagnostic avenues available to cater high patient load at tertiary hospital level. A high dependence on these factors is highly valuable in developing countries in diagnosis of pulmonary embolism. The review has been written to remind and highlight the importance of clinical history and signs supplemented with Well's score in diagnosis of the pulmonary embolism in tertiary care level handling excess patient load than its capacity and financial constraints of middle class patient limiting access for undergoing modern radiological investigations for diagnosis of pulmonary embolism.