52-year-old male with history of COPD and cor pulmonale presents with severe respiratory distress and failure. The 
patient’s wife states this was worse than any other COPD exacerbation he has ever had. He has no prior history of DVT-PE but you are concerned that the patient may have had a PE. Despite aggressive medical management, the patient’s respiratory status worsens and he requires emergency intubation. Due to your concern for a possible PE, you perform a focused echo and note the following…
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