CHIEF COMPLAINT: 70M who had severe headache.

PRESENT ILLNESS: This 70 year old white male is s/p aortic repair in [**2117**] and
presented to the ED with severe headache which increased with
movement of the neck.  He had neck stiffness for a few days
prior to admission. When he presented to the ED his BP was
190/100.

MEDICAL HISTORY: S/p Aortic repair [**2117**] @ [**Hospital1 2025**]
?PE
Chronic AF
Gout
Hypothyroidism
^chol.
Hypothyroidism
L Rotator cuff tendonitis
s/p umbilical hernia repair
s/p appy

MEDICATION ON ADMISSION: Coumadin
Zocor
ASA
Levoxyl
Allopurinol
Proscar
Amoxicillin (for ? leg cellulitis).

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: Gen: Elderly white male in NAD
BP: 190/100, afeb, HR: 65
HEENT: NC/AT, PERLA, EOMI, oropharynx benign
Neck: supple, FROM, no lymphadenopathy or thyromegaly, carotids
2+=bilat. without bruits.
Lungs: Clear to A+P
CV: IRRR without R/G, II/VI SEM
Abd: +BS, soft, nontender, no masses or hepatosplenomegaly
Ext: 2+ bil. pedal edema w/ errythema, pulses 2+=bilat.
throughout.
Neuro: nonfocal

FAMILY HISTORY: Unremarkable

SOCIAL HISTORY: Cigs: none
ETOH: none
Lives with wife.
Dissection of aorta, thoracoabdominal,Atrial fibrillation,Gout, unspecified,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Aneurysm of iliac artery,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status
Dsct of thoracoabd aorta,Atrial fibrillation,Gout NOS,Pure hypercholesterolem,Hypothyroidism NOS,Hypertension NOS,Iliac artery aneurysm,Crnry athrscl natve vssl,Aortocoronary bypass
Admission Date:  [**2119-8-21**]              Discharge Date:   [**2119-8-22**]

Date of Birth:  [**2048-11-21**]             Sex:   M

Service: SURGERY

Allergies:
No Drug Allergy Information on File

Attending:[**First Name3 (LF) 2597**]
Chief Complaint:
70M who had severe headache.

Major Surgical or Invasive Procedure:
None


History of Present Illness:
This 70 year old white male is s/p aortic repair in [**2117**] and
presented to the ED with severe headache which increased with
movement of the neck.  He had neck stiffness for a few days
prior to admission. When he presented to the ED his BP was
190/100.


Past Medical History:
S/p Aortic repair [**2117**] @ [**Hospital1 2025**]
?PE
Chronic AF
Gout
Hypothyroidism
^chol.
Hypothyroidism
L Rotator cuff tendonitis
s/p umbilical hernia repair
s/p appy

Social History:
Cigs: none
ETOH: none
Lives with wife.

Family History:
Unremarkable

Physical Exam:
Gen: Elderly white male in NAD
BP: 190/100, afeb, HR: 65
HEENT: NC/AT, PERLA, EOMI, oropharynx benign
Neck: supple, FROM, no lymphadenopathy or thyromegaly, carotids
2+=bilat. without bruits.
Lungs: Clear to A+P
CV: IRRR without R/G, II/VI SEM
Abd: +BS, soft, nontender, no masses or hepatosplenomegaly
Ext: 2+ bil. pedal edema w/ errythema, pulses 2+=bilat.
throughout.
Neuro: nonfocal

Pertinent Results:
[**2119-8-22**] 03:28AM BLOOD WBC-9.5 Hct-33.7* Plt Ct-141*
[**2119-8-22**] 03:28AM BLOOD PT-19.4* PTT-35.9* INR(PT)-2.5
[**2119-8-21**] 05:30PM BLOOD D-Dimer-1132*
[**2119-8-22**] 03:28AM BLOOD Glucose-166* UreaN-16 Creat-1.1 Na-142
K-3.8 Cl-109* HCO3-24 AnGap-13
[**2119-8-22**] 03:28AM BLOOD CK(CPK)-30*
[**2119-8-22**] 03:28AM BLOOD CK-MB-NotDone cTropnT-0.01
[**2119-8-22**] 03:28AM BLOOD Calcium-9.2 Phos-2.8 Mg-2.3
[**2119-8-22**] 03:33AM BLOOD Type-ART pO2-102 pCO2-37 pH-7.44
calHCO3-26 Base XS-0
   RADIOLOGY   Preliminary Report

CHEST (PA & LAT)  [**2119-8-21**] 6:09 PM

CHEST (PA & LAT)

Reason: r/o pe

[**Hospital 93**] MEDICAL CONDITION:
70 year old man with h/a htn pmh p.e
REASON FOR THIS EXAMINATION:
r/o pe
INDICATION: 70-year-old man with headache, hypertension, and
past medical history of pulmonary embolism. Evaluate for
pulmonary embolism.

COMPARISON: None.

PA AND LATERAL VIEWS OF THE CHEST: The patient is status post
coronary artery bypass graft, with sternal wires in place. The
cardiac silhouette is slightly enlarged, with left ventricular
prominence. The aortic silhouette is extremely dilated up to 5.5
mm, concerning for aneurysm or dissection. Pulmonary vasculature
is normal. Both lungs are grossly clear, without consolidations
or effusions. The surrounding soft tissue and osseous structures
reveal degenerative changes along the thoracic spine, with mild
anterior wedging of some upper/mid thoracic vertebral bodies.

IMPRESSION: Severe dilatation of the intrathoracic aorta,
concerning for aneurysm or dissection.

These findings were called to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at 7:00 p.m. on
[**2119-8-21**].

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 6892**]
RADIOLOGY  Final Report

CT HEAD W/O CONTRAST  [**2119-8-21**] 6:21 PM

CT HEAD W/O CONTRAST

Reason: bleed

[**Hospital 93**] MEDICAL CONDITION:
70 year old man with severe headache
REASON FOR THIS EXAMINATION:
bleed
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: 70-year-old with headache.

CT OF THE BRAIN WITHOUT IV CONTRAST. No prior studies.

There is no acute intracranial hemorrhage, shift of normally
midline structures, or hydrocephalus. [**Doctor Last Name **]-white matter
differentiation appears preserved. Soft tissues and osseous
structures are unremarkable. The visualized paranasal sinuses
demonstrate minimal thickening within the ethmoid air cells.

IMPRESSION:

No acute intracranial hemorrhage.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name (STitle) 7853**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
DR. [**First Name (STitle) 23303**] [**Doctor Last Name **]
Approved: TUE [**2119-8-22**] 7:50 AM
RADIOLOGY   Preliminary Report

CTA CHEST W&W/O C &RECONS  [**2119-8-21**] 7:30 PM

CTA CHEST W&W/O C &RECONS; CTA ABD W&W/O C & RECONS

Reason: R/O DISSECTION
Field of view: 41 Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
70 year old man with AORTIC REPAIR AND BACK/NECK PAIN
REASON FOR THIS EXAMINATION:
R/O DISSECTION
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: 70-year-old with history of prior aortic repair now
with neck and back pain.

TECHNIQUE: VCT images of the chest without IV contrast. VCT
images of the chest, abdomen, and pelvis after the
administration of IV contrast. Multiplanar reformatted images
were obtained.

No prior studies for comparison.

CT OF THE CHEST PRE- AND POST-IV CONTRAST: There are no pleural
effusions. Several small shoddy lymph nodes are seen within the
mediastinum and both axilla. No pathologically enlarged lymph
nodes are identified. Lung window images demonstrate bibasilar
atelectasis. There is also a small ill-defined nodule measuring
approximately 7 mm in the right upper lobe anteriorly. There is
no area of focal consolidation. The bronchi are patent to the
segmental level. The heart is slightly enlarged. The pericardium
is normal. Coronary calcifications are evident within the left
anterior descending and circumflex coronary arteries.

CT OF THE ABDOMEN POST-IV CONTRAST: 2 small hypodensities are
seen within the inferior most margin of the right lobe of the
liver, which are too small to characterize, but likely represent
cysts. The remainder of the liver is unremarkable. The spleen,
pancreas, adrenals are normal in appearance. Hypodensities are
seen within both kidneys consistent with cysts. The patient is
post cholecystectomy. The intraabdominal large and small bowel
are normal in appearance. A few small nonpathologically enlarged
lymph nodes are seen scattered throughout the abdomen. There is
no free air or free fluid.

CT OF THE PELVIS WITH IV CONTRAST: The upper pelvis was imaged.
There is no free fluid. The visualized portions of the distal
ureters are normal in appearance.

CT ANGIOGRAM: There is evidence of prior aortic surgery with
clips and what appears to be an anastomosis just superior to the
native aortic valve. No aortic graft is identified.
Calcification is seen throughout the intrathoracic aorta. There
is a dissection flap seen within the aorta, which begins in the
ascending aorta and continues into the abdominal aorta,
terminating just below the level of the renal arteries. Contrast
is seen to fill both the true and false lumens of the
dissection. Within the false lumen, contrast has a swirling
appearance. Note is made of dilation of the left coronary sinus.
The aortic branch vessels all originate from the true lumen, and
there is no evidence of extension of the dissection into the
branch vessels. The left common carotid is noted to be quite
tortuous at its origin. The descending thoracic aorta is
markedly narrowed in its distal portion just above the
diaphragmatic hiatus, where it measures 11 mm in transverse
diameter.

Contrast enhancement is seen within the celiac, superior
mesenteric, and renal arteries. The celiac artery is stenotic,
and there is post stenotic dilation. The superior mesenteric
artery is normal in appearance. There are 3 right-sided renal
arteries and 2 left-sided renal arteries, all of which originate
from the true lumen and demonstrate contrast enhancement. Both
iliac arteries are aneurysmal in appearance. The left iliac
artery measures 3.4 cm in greatest transverse diameter, and the
right iliac artery measures 2.1 cm in greatest transverse
diameter. Calcification is seen throughout the intraabdominal
aorta and the iliac arteries.

There is no evidence of pulmonary embolus.

The soft tissues are normal in appearance. The osseous
structures demonstrate degenerative changes throughout the
thoracic and lumbar spine. In addition, severe degenerative
changes are seen within the left shoulder joint. Bridging
osteophytes are seen around both sacroiliac joints.

Multiplanar reformatted images confirm the above findings. MPR
grade value III.

IMPRESSION:

1. There is evidence of prior aortic surgery as documented
above. No aortic graft is identified, and there is an extensive
aortic dissection beginning in the ascending aorta and extending
into the infrarenal abdominal aorta. Enhancement is seen within
both the true and false lumen. This likely represents
fenestration during prior dissection repair. It is unable to
assess the degree, and extent of the dissection without
comparison examinations. However, the branch vessels from the
aortic arch as well as the renal arteries, celiac, and superior
mesenteric arteries all originate from the true lumen and are
patent.

2. Dilation of the left sinus of Valsalva.

3. Stenosis at the origin of the celiac artery with
post-stenotic dilation.

4. Bilateral iliac artery aneurysms, left greater than right.

5. Right upper lobe ill-defined nodular density. Comparison with
prior examinations is recommended. If no examinations are
available, this nodule should be followed up.

If available, outside prior CT examinations should be obtained
for comparison.

The above findings were reviewed with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at the
completion of the examination.

DR. [**First Name (STitle) 7853**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 6892**]
RADIOLOGY   Preliminary Report

CTA ABD W&W/O C & RECONS  [**2119-8-21**] 7:30 PM

CTA CHEST W&W/O C &RECONS; CTA ABD W&W/O C & RECONS

Reason: R/O DISSECTION
Field of view: 41 Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
70 year old man with AORTIC REPAIR AND BACK/NECK PAIN
REASON FOR THIS EXAMINATION:
R/O DISSECTION
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: 70-year-old with history of prior aortic repair now
with neck and back pain.

TECHNIQUE: VCT images of the chest without IV contrast. VCT
images of the chest, abdomen, and pelvis after the
administration of IV contrast. Multiplanar reformatted images
were obtained.

No prior studies for comparison.

CT OF THE CHEST PRE- AND POST-IV CONTRAST: There are no pleural
effusions. Several small shoddy lymph nodes are seen within the
mediastinum and both axilla. No pathologically enlarged lymph
nodes are identified. Lung window images demonstrate bibasilar
atelectasis. There is also a small ill-defined nodule measuring
approximately 7 mm in the right upper lobe anteriorly. There is
no area of focal consolidation. The bronchi are patent to the
segmental level. The heart is slightly enlarged. The pericardium
is normal. Coronary calcifications are evident within the left
anterior descending and circumflex coronary arteries.

CT OF THE ABDOMEN POST-IV CONTRAST: 2 small hypodensities are
seen within the inferior most margin of the right lobe of the
liver, which are too small to characterize, but likely represent
cysts. The remainder of the liver is unremarkable. The spleen,
pancreas, adrenals are normal in appearance. Hypodensities are
seen within both kidneys consistent with cysts. The patient is
post cholecystectomy. The intraabdominal large and small bowel
are normal in appearance. A few small nonpathologically enlarged
lymph nodes are seen scattered throughout the abdomen. There is
no free air or free fluid.

CT OF THE PELVIS WITH IV CONTRAST: The upper pelvis was imaged.
There is no free fluid. The visualized portions of the distal
ureters are normal in appearance.

CT ANGIOGRAM: There is evidence of prior aortic surgery with
clips and what appears to be an anastomosis just superior to the
native aortic valve. No aortic graft is identified.
Calcification is seen throughout the intrathoracic aorta. There
is a dissection flap seen within the aorta, which begins in the
ascending aorta and continues into the abdominal aorta,
terminating just below the level of the renal arteries. Contrast
is seen to fill both the true and false lumens of the
dissection. Within the false lumen, contrast has a swirling
appearance. Note is made of dilation of the left coronary sinus.
The aortic branch vessels all originate from the true lumen, and
there is no evidence of extension of the dissection into the
branch vessels. The left common carotid is noted to be quite
tortuous at its origin. The descending thoracic aorta is
markedly narrowed in its distal portion just above the
diaphragmatic hiatus, where it measures 11 mm in transverse
diameter.

Contrast enhancement is seen within the celiac, superior
mesenteric, and renal arteries. The celiac artery is stenotic,
and there is post stenotic dilation. The superior mesenteric
artery is normal in appearance. There are 3 right-sided renal
arteries and 2 left-sided renal arteries, all of which originate
from the true lumen and demonstrate contrast enhancement. Both
iliac arteries are aneurysmal in appearance. The left iliac
artery measures 3.4 cm in greatest transverse diameter, and the
right iliac artery measures 2.1 cm in greatest transverse
diameter. Calcification is seen throughout the intraabdominal
aorta and the iliac arteries.

There is no evidence of pulmonary embolus.

The soft tissues are normal in appearance. The osseous
structures demonstrate degenerative changes throughout the
thoracic and lumbar spine. In addition, severe degenerative
changes are seen within the left shoulder joint. Bridging
osteophytes are seen around both sacroiliac joints.

Multiplanar reformatted images confirm the above findings. MPR
grade value III.

IMPRESSION:

1. There is evidence of prior aortic surgery as documented
above. No aortic graft is identified, and there is an extensive
aortic dissection beginning in the ascending aorta and extending
into the infrarenal abdominal aorta. Enhancement is seen within
both the true and false lumen. This likely represents
fenestration during prior dissection repair. It is unable to
assess the degree, and extent of the dissection without
comparison examinations. However, the branch vessels from the
aortic arch as well as the renal arteries, celiac, and superior
mesenteric arteries all originate from the true lumen and are
patent.

2. Dilation of the left sinus of Valsalva.

3. Stenosis at the origin of the celiac artery with
post-stenotic dilation.

4. Bilateral iliac artery aneurysms, left greater than right.

5. Right upper lobe ill-defined nodular density. Comparison with
prior examinations is recommended. If no examinations are
available, this nodule should be followed up.

If available, outside prior CT examinations should be obtained
for comparison.

The above findings were reviewed with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at the
completion of the examination.

DR. [**First Name (STitle) 7853**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 6892**]














Brief Hospital Course:
This 70 year old male was admitted to the CSRU from the ED and
was evaluated by cardiac surgery, vascular surgery, and
cardiology.  He was started on Labetolol and his HR blocked to
the 50's, so he was changed to Nipride and Cardene.  His BP
decreased to the 120's.  His films were reviewed by Dr.
[**Last Name (STitle) 1290**] and he spoke with Dr. [**Last Name (STitle) 40858**] who wanted to tx.
him to [**Hospital1 2025**].

Medications on Admission:
Coumadin
Zocor
ASA
Levoxyl
Allopurinol
Proscar
Amoxicillin (for ? leg cellulitis).

Discharge Medications:
1. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.
5. Nitroprusside Sodium 25 mg/mL Solution Sig: 0.3 mg/kg/hr
Intravenous  TITRATE TO (titrate to desired clinical effect
(please specify)).
6. Nicardipine 2.5 mg/mL Solution Sig: Three (3) mg/kg/min
Intravenous  INFUSION (continuous infusion).


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Thorocoabdominal aortic dissection
s/p aortic repair
chronic Afib
Gout
^chol.
Hypothyroidism
L rotator cuff tendonitis
s/p umbilical hernia repair
s/p appy


Discharge Condition:
Fair.

Discharge Instructions:
Tx to acute facility.
Tx to acute facility.

Followup Instructions:
Transfer to Dr. [**Last Name (STitle) 40858**] at [**Hospital1 2025**]



Completed by:[**2119-8-22**]
{'Dissection of aorta, thoracoabdominal,Atrial fibrillation,Gout, unspecified,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Aneurysm of iliac artery,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: 70M who had severe headache.

PRESENT ILLNESS: This 70 year old white male is s/p aortic repair in [**2117**] and
presented to the ED with severe headache which increased with
movement of the neck.  He had neck stiffness for a few days
prior to admission. When he presented to the ED his BP was
190/100.

MEDICAL HISTORY: S/p Aortic repair [**2117**] @ [**Hospital1 2025**]
?PE
Chronic AF
Gout
Hypothyroidism
^chol.
Hypothyroidism
L Rotator cuff tendonitis
s/p umbilical hernia repair
s/p appy

MEDICATION ON ADMISSION: Coumadin
Zocor
ASA
Levoxyl
Allopurinol
Proscar
Amoxicillin (for ? leg cellulitis).

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: Gen: Elderly white male in NAD
BP: 190/100, afeb, HR: 65
HEENT: NC/AT, PERLA, EOMI, oropharynx benign
Neck: supple, FROM, no lymphadenopathy or thyromegaly, carotids
2+=bilat. without bruits.
Lungs: Clear to A+P
CV: IRRR without R/G, II/VI SEM
Abd: +BS, soft, nontender, no masses or hepatosplenomegaly
Ext: 2+ bil. pedal edema w/ errythema, pulses 2+=bilat.
throughout.
Neuro: nonfocal

FAMILY HISTORY: Unremarkable

SOCIAL HISTORY: Cigs: none
ETOH: none
Lives with wife. 

### Response:
{'Dissection of aorta, thoracoabdominal,Atrial fibrillation,Gout, unspecified,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Aneurysm of iliac artery,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status'}
