The European Society of Cardiology (ESC) Guidelines for the diagnosis and management of acute pulmonary embolism (PE), developed in collaboration with the European Respiratory Society (ERS), were updated in 2019. The European Journal of Internal Medicine has published an elegantly written commentary by Vedovati and colleagues [1], highlighting and critically reviewing some of the new recommendations. This article provides an excellent opportunity to explain and justify the main novelties and changes in the updated version of the ESC Guidelines, and also to put the remaining unanswered questions into perspective.