Review Question - QID 210518

A 65-year-old man presents to the emergency department for shortness of breath. He was at home working on his car when he suddenly felt very short of breath, which failed to improve with rest. He was working with various chemicals and inhalants while trying to replace a broken piece in the engine. The patient was brought in by paramedics and is currently on 100% O2 via nasal cannula. The patient has a 52-pack-year smoking history and drinks 2 to 3 alcoholic drinks every night. He has a medical history of asthma but admits to not having seen a physician since high school. His temperature is 98.2°F (36.8°C), blood pressure is 157/108 mmHg, pulse is 120/min, respirations are 29/min, and oxygen saturation is 77%. Physical exam demonstrates tachycardia with a systolic murmur heard best along the right upper sternal border. Breath sounds are diminished over the right upper lobe only. Bilateral lower extremity pitting edema is noted. Which of the following describes the most likely diagnosis?