Correct!
5. There is no pulmonary embolism.

The CT scan shows the aforementioned left pleural effusion and atelectasis. There is no pulmonary embolism. Had there been a pulmonary embolism surgical therapy is rarely done except in the presence of massive embolism with right heart failure. Anticoagulation would carry increased risk because of the recent operation.

What should be done next?

1. Repeat echocardiogram with a bubble study
2. Pulmonary angiogram
3. Chest tube insertion to drain the left pleural effusion
4. Intermittent positive pressure breathing to relieve the atelectasis
5. Surgical correction of the leaking thoracic aortic aneurysm

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