A 42-Year-Old Man Comes to the Emergency Department Due to Several

A 42-year-old man comes to the emergency department due to several hours of dyspnea.  He is a long-haul truck driver who became acutely short of breath during a 36-hour trip but previously had been healthy.  The patient smokes a pack of cigarettes daily and drinks a 6-pack of beer on weekends.  Pulmonary examination reveals vesicular breath sounds bilaterally with the overlying areas resonant to percussion.  CT pulmonary angiogram shows a right lower lobe pulmonary artery occlusion consistent with pulmonary embolism but no evidence of pulmonary infarction.  Which of the following is the most likely reason for the lack of lung tissue necrosis in this patient?

A) Collateral circulation
B) Decreased surfactant
C) Endothelial tissue plasminogen activator
D) Increased pulmonary venous pressure
E) Intrapulmonary shunting

Correct Answer:

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