CHIEF COMPLAINT: Submental Abscess

PRESENT ILLNESS: 18yF s/p mandibular molar (#28) extraction on [**2116-2-12**] presents
with increasing submental swelling and pain.  Pt was admitted to
[**Hospital1 18**] on [**2-17**] for facial swelling and was evaluated by our
service at that time.  CT scan showed no abscess.  Pt was
discharged on [**2-19**] for Clindamycin.  Pt states that though the
facial swelling had improved, the chin swelling had persisted.
Pt reports dysphagia and odynophagia though she can tolerate PO.
 Pt denies any SOB, but does have changes in voice.

MEDICAL HISTORY: s/p mandibular tooth extraction as above

MEDICATION ON ADMISSION: clindamycin, motrin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T:
Gen: AAOx3, NAD, Breathing comfortably, no stridor
Ears: normal pinnae
Nose: normal external exam, normal mucosa, no mass
OC/OP: trismus improved, FOM soft, normal mucosa, normal tongue
mobility
Neck: mild submental edema and erythema without fluctuance,
incision C/D/I

FAMILY HISTORY: NC

SOCIAL HISTORY: Has an 8mo old at home, no alcohol, tobacco.
Other postoperative infection,Cellulitis and abscess of face,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places
Other postop infection,Cellulitis of face,Abn react-procedure NEC,Accident in place NEC
Admission Date:  [**2116-2-25**]              Discharge Date:   [**2116-3-2**]

Date of Birth:  [**2097-11-1**]             Sex:   F

Service: OTOLARYNGOLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 12657**]
Chief Complaint:
Submental Abscess

Major Surgical or Invasive Procedure:
Incision and drainage of submental abscess


History of Present Illness:
18yF s/p mandibular molar (#28) extraction on [**2116-2-12**] presents
with increasing submental swelling and pain.  Pt was admitted to
[**Hospital1 18**] on [**2-17**] for facial swelling and was evaluated by our
service at that time.  CT scan showed no abscess.  Pt was
discharged on [**2-19**] for Clindamycin.  Pt states that though the
facial swelling had improved, the chin swelling had persisted.
Pt reports dysphagia and odynophagia though she can tolerate PO.
 Pt denies any SOB, but does have changes in voice.

Past Medical History:
s/p mandibular tooth extraction as above

Social History:
Has an 8mo old at home, no alcohol, tobacco.


Family History:
NC

Physical Exam:
T:
Gen: AAOx3, NAD, Breathing comfortably, no stridor
Ears: normal pinnae
Nose: normal external exam, normal mucosa, no mass
OC/OP: trismus improved, FOM soft, normal mucosa, normal tongue
mobility
Neck: mild submental edema and erythema without fluctuance,
incision C/D/I


Pertinent Results:
[**2116-2-25**] WBC-10.5 RBC-4.38 Hgb-12.1 Hct-36.1 Plt Ct-400
[**2116-2-27**] WBC-8.5 RBC-3.95* Hgb-11.1* Hct-32.6* Plt Ct-369
[**2116-2-25**] Neuts-78.6* Lymphs-15.3* Monos-4.7 Eos-1.3 Baso-0.2

[**2116-2-25**] PT-12.3 PTT-24.2 INR(PT)-1.1
[**2116-2-27**] PT-12.8 PTT-21.3* INR(PT)-1.1

[**2116-2-25**] Glucose-79 UreaN-8 Creat-0.6 Na-140 K-3.7 Cl-104
HCO3-26
[**2116-2-27**] Glucose-129* UreaN-3* Creat-0.7 Na-140 K-4.3 Cl-105
HCO3-29
[**2116-2-26**] Calcium-9.2 Phos-3.6 Mg-1.6
[**2116-2-27**] Calcium-9.0 Phos-5.0* Mg-1.7
[**2116-2-25**] Lactate-1.1

[**2116-2-25**] URINE UCG-NEGATIVE

IMAGING:
CT SINUS W/ CONTRAST  [**2116-2-25**] 4:18 PM
Reason: please evaluate for abscess
Contrast: [**Hospital 13288**]
[**Hospital 93**] MEDICAL CONDITION:
18 year old woman with recent tooth extraction and bacteremia
presents with submandibular swelling concerning for abscess
REASON FOR THIS EXAMINATION:
please evaluate for abscess
CONTRAINDICATIONS for IV CONTRAST: None.

CT SINUS WITH CONTRAST, [**2116-2-25**] AT 16:55 HOURS.

HISTORY: Recent tooth extraction and bacteremia with
submandibular swelling.

TECHNIQUE: Serial transverse images were acquired sequentially
through the maxillofacial complex and mandible and reconstructed
at stacked 5 mm increments utilizing bone and soft tissue window
algorithms. Coronal and sagittal reformatted images were
generated. Images were obtained following the uneventful
administration of 70 ml Optiray 350 intravenous contrast
material.

COMPARISON: None.

FINDINGS: There is a fluid collection with rim enhancement
measuring approximately 30 mm AP x 26 mm transverse x 20 mm
cephalocaudad in the floor of the mouth interpose between the
geniohyoid muscles superiorly and the mylohyoid muscle
inferiorly. The collection has one small locule of internal air.
Extensive inflammatory reaction is noted adjacent to the
collection. Small submental lymph nodes are seen in the
regionally. There is a linear defect approximately 11 mm deep in
the superficial submental soft tissues poitning towards the
anterior margin of the collection suggestive of a possible sinus
tract, although complete communication is not demonstrated.
There is internal high attenuation material of unknown etiology,
which may represent an imbedded foreign body. There is no
evidence of bony erosion or other involvement. The first
premolar on the right is absent, likely related to the recent
extraction. Prominent 8 mm short axis lymph nodes are noted
throughout the bilateral jugulodigastric lymph node chains. No
definite cervical lymph adenopathy is identified. Vessels are
patent. The submandibular, parotid, and thyroid glands image
normally. The airway is widely patent. The epiglottis and
aryepiglottic folds are within normal limits. The included
paranasal sinuses are clear. Likewise, no fluid is seen in the
mastoid air cells or the middle ear cavities.

IMPRESSION: Floor of mouth abscess with mildly reactive regional
lymph nodes. There is suggestion of a sinus tract and question
of possible embedded radiopaque foreign body. Correlate with
physical exam.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 7411**]


CHEST (PRE-OP PA & LAT)  [**2116-2-25**] 8:15 PM
Reason: pre-op

[**Hospital 93**] MEDICAL CONDITION:
18 year old woman with submental abscess
REASON FOR THIS EXAMINATION:
pre-op
INDICATION: 18-year-old woman with submental abscess. Preop.

PRE-OP PA AND LATERAL CHEST: Heart size, mediastinal and hilar
contours appear normal. The lungs are clear. No consolidations,
effusions, or edema are seen.

IMPRESSION: No acute cardiopulmonary process.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name (STitle) 46933**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 7411**]
Approved: WED [**2116-2-26**] 11:26 PM

MICROBIOLOGY:
Blood cultures [**2116-2-25**]: pending x2

[**2116-2-25**] 5:00 pm SWAB     Site: JAW
   GRAM STAIN (Final [**2116-2-25**]):
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.
   WOUND CULTURE (Preliminary):    NO GROWTH.
   ANAEROBIC CULTURE (Pending):

[**2116-2-26**] 3:35 pm SWAB
   GRAM STAIN (Final [**2116-2-26**]):
      2+   (1-5 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.
   WOUND CULTURE (Pending):


Brief Hospital Course:
Patient presented to the ED and an I&D of a fluctuant submental
area was performed resulting in a small amount of pus.  Culture
swab and blood cultures were sent.  Pt was afebrile and did not
have elevated WBC.  Pt was started on IV unasyn.  CT scan
demonstrated another larger abscess and patient was admitted
from ED to ICU on [**2116-2-25**] for continuous oxygen saturation and
overall respiratory status monitoring given possibility of
progression to Ludwigs.  Patient did not have any events and was
pre-op'd for incision and drainage of her submental abscess.
Patient underwent her procedure on [**2116-2-26**] where ~10cc purulent
material was expressed.  Culture swabs were sent.  A penrose
drain was left in place to allow continued drainage of abscess
space.  Pt tolerated the procedure well and returned to ICU for
continued respiratory status monitoring x24 hours.  Pt did well
without any events was transferred to floor tolerating PO intake
and breathing comfortably on [**2116-2-27**], POD#1.  Starting on POD#2,
the penrose drain was slowly removed from the abscess cavity
daily and she was discharged home on [**2116-3-3**] once the penrose
was advanced out.

Medications on Admission:
clindamycin, motrin


Discharge Medications:
1. Augmentin 875-125 mg Tablet Sig: One (1) Tablet PO twice a
day for 10 days.
Disp:*20 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Submental abscess


Discharge Condition:
Stable


Discharge Instructions:
Please take your medications as prescribed.  Please call Dr. [**Name (NI) 71084**] office/return to [**Hospital1 18**] if you experience persistent
fever (Temp>101.5), pain/swelling/bleeding/drainage from
surgical site, difficulty swallowing/breathing.

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) 3878**] in 1 week, please call ([**Telephone/Fax (1) 53978**] for an appointment.
{'Other postoperative infection,Cellulitis and abscess of face,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places'}


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: Submental Abscess

PRESENT ILLNESS: 18yF s/p mandibular molar (#28) extraction on [**2116-2-12**] presents
with increasing submental swelling and pain.  Pt was admitted to
[**Hospital1 18**] on [**2-17**] for facial swelling and was evaluated by our
service at that time.  CT scan showed no abscess.  Pt was
discharged on [**2-19**] for Clindamycin.  Pt states that though the
facial swelling had improved, the chin swelling had persisted.
Pt reports dysphagia and odynophagia though she can tolerate PO.
 Pt denies any SOB, but does have changes in voice.

MEDICAL HISTORY: s/p mandibular tooth extraction as above

MEDICATION ON ADMISSION: clindamycin, motrin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T:
Gen: AAOx3, NAD, Breathing comfortably, no stridor
Ears: normal pinnae
Nose: normal external exam, normal mucosa, no mass
OC/OP: trismus improved, FOM soft, normal mucosa, normal tongue
mobility
Neck: mild submental edema and erythema without fluctuance,
incision C/D/I

FAMILY HISTORY: NC

SOCIAL HISTORY: Has an 8mo old at home, no alcohol, tobacco. 

### Response:
{'Other postoperative infection,Cellulitis and abscess of face,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places'}
