Case of the Week — September Case #2: Shortness of Breath

38 y/o AAM presents to the ED with complaints of epigastric pain radiating to his chest for 1 week. He admits to SOB, but denies N/V/D or cough. Subjective F/C and generalized body aches. Recent weight loss of >50 lbs in the past several months. PMHx: HTN PSHx: none SocHx: h/o tobaco use, but quit recently; occasional ETOH; marijuana and cocaine use FamHx: none PE: BP 173/117, P 101, R 18, T 98.3, Pox 100% (RA) GEN: WNWD, AAM, NAD CHEST: CTA B, nonlabored CV: RRR, IV/VI SEM, +bruit/thrill ABD: soft, NTND, +BS EXT: no C/C/E, no splinter hemorrhages Bedside US is performed as the patient is without history of a murmur: What is your diagnosis? What is on your differential for etiology of this diagnosis?