What does this IVC ultrasound suggest?

A 52 year-old male presents to the ED with acute onset of shortness of breath and chest pain.  He has a history of hypertension, hypercholesterolemia, and diabetes.  His initial vital signs show a HR of 126, RR 34, BP 110/76, O2 sats of 93% on RA, and temp of 37.6.  During his assessment, a bedside ultrasound of his IVC is performed. 

What do you think of the IVC?

What is in your differential?

What else do you want to scan on this patient?

IVC US.jpg