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Mr Smith is a 56 year old man who attends A&E as he reports chest pain and shortness of breath that has developed suddenly around 3 hours ago. He was diagnosed with Rheumatoid Arthritis 14 years ago and this is currently well controlled with weekly Methotrexate. On examination, he has reduced air entry in the left lower zone.

Based on the above information, what is the most likely diagnosis?

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