Findings:
There is a saddle pulmonary embolus in the bilateral main pulmonary arteries.  This extends into the superior and inferior lobar and subsequent segmental branches. There is complete occlusion of the right lower segmental artery with near complete occlusion of the left lower lobe pulmonary artery.

The right ventricle is enlarged with suggestion of ventral septal flattening concerning for right heart strain. The pacemaker leads terminate in the right ventricular apex and right atrium. The main pulmonary artery is borderline enlarged, measuring up to 3.0cm.

There is infarction of the right lower lobe identified as complete consolidation with air bronchograms.

Impression:
Large burden saddle pulmonary embolus with extension into the bilateral lobar and segmental branches resulting in right heart strain.

There is complete occlusion of the right lower lobe pulmonary artery with suggestion of right lower lobe lung infarction.

There is near complete occlusion of the left lower lobe pulmonary artery.

Recommendations:
For your training purposes, recommendations are not included in this report.