Background: Acute pulmonary embolism (PE) is a life-threatening condition requiring prompt diagnosis and assessment of disease severity. CT pulmonary angiography (CTPA) enables direct visualisation of pulmonary arterial thrombi and evaluation of right ventricular strain and alternative thoracic abnormalities. Aim: To evaluate the role of CTPA in diagnosing acute PE and characterising thrombus distribution, pulmonary arterial obstruction, right ventricular strain and additional thoracic findings. Methods: This retrospective cross-sectional observational study included 120 patients clinically suspected of acute PE who underwent CTPA at a tertiary care centre. CTPA findings were assessed for the presence and anatomical distribution of emboli, Qanadli CT obstruction index (CTOI), CT markers of right ventricular strain and alternative diagnoses. Clinical characteristics and Wells score categories were compared with CTPA findings. Results: PE was detected in 22 patients (18.3%). Among the 98 PE-negative patients, alternative thoracic abnormalities were identified in 70 (71.4%). Dyspnoea, tachycardia, previous deep vein thrombosis or PE, prolonged immobilisation, higher heart rate and lower oxygen saturation were significantly associated with PE. CTPA positivity increased from 3.7% in the low Wells score category to 22.4% in the intermediate and 52.9% in the high category (p<0.001). Segmental involvement (45.5%) and bilateral disease (59.1%) were the predominant patterns. Mean CTOI was 23.7 ± 15.2%. Central PE showed higher CTOI and greater right ventricular strain than peripheral PE. CTOI correlated strongly with the right-to-left ventricular diameter ratio (Spearman’s rₛ=0.951; p<0.001). Conclusion: CTPA provided diagnostic and anatomical characterisation of acute PE, enabled assessment of pulmonary arterial obstruction and right ventricular strain, and identified alternative thoracic abnormalities. Its integration with clinical probability assessment may support compreh