PURPOSE: To evaluate the safety of pulmonary angiography performed with iopamidol compared with pulmonary angiography performed with ionic contrast media. MATERIALS AND METHODS: The data in 1,434 patients who underwent pulmonary angiography with iopamidol 76% were retrospectively reviewed. Complications that occurred within 48 hours were identified with review of hospital charts and/or computer records. RESULTS: Pulmonary arterial hypertension was present in 402 patients and was severe in 99. Pulmonary embolus was diagnosed in 357 patients (24.9%). Major complications occurred in four patients (0.3%). Respiratory insufficiency occurred in two of these patients. Catheterization was not completed in two patients due to catheter-induced cardiac arrhythmia that was refractory to treatment. No procedure-related deaths occurred. During the periprocedural period, eight patients required intubation and 10 patients died; all patients previously were critically ill. CONCLUSION: Pulmonary angiography is a safe procedure, and the margin of safety is enhanced by the use of iopamidol.