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A 62-year-old woman presents with sudden onset dyspnea and pleuritic chest pain. She has a past medical history of recurrent deep vein thrombosis and has been non-compliant with her anticoagulant therapy. Her blood pressure is 160/90 mmHg, heart rate is 110 bpm, and oxygen saturation is 89% on room air. Which of the following findings on imaging is most specific for a diagnosis of pulmonary embolism?