A 52-year-old man with metastatic pancreatic adenocarcinoma (stage IV, liver and peritoneal involvement) presents with acute onset of dyspnea, chest pain, and hemoptysis. He also reports oozing from a recent tooth extraction site and dark urine. Vital signs: BP 88/54 mmHg, HR 126/min, RR 28/min, O₂ saturation 88% on room air. Laboratory: Hb 8.9 g/dL, WBC 14,200/μL, platelets 32,000/μL, PT 22 sec (control 12), aPTT 68 sec (control 36), fibrinogen 78 mg/dL, D-dimer 8.5 μg/mL (normal <0.5). Chest X-ray shows bilateral infiltrates. What is the most likely diagnosis?