CHIEF COMPLAINT: Swollen R arm

PRESENT ILLNESS: 42 M with adeno lung ca, s/p XRT/[**Doctor Last Name **]/taxol, h/o SVC syndrome
with multiple stents, who comes today with right shoulder pain.
He also reports some right finger tip numbness, no lossof
function or strentght. Deneis F/C/chest pain/SOB/N/V.
.
Of note was on lovenox [**Hospital1 **] dosing. This was decreased in
Novermber 13, [**2190**] b/c pt had somehematuria. He notes hematuria
after an erection ,then passes a clot and then normal urine.
Some discomfort but no pain. He had this last 10 days ago. No
BRBRPR or change in stool color.
.
In the ED, VS stable. EKG no changes. CXR clear. IR called who
has pt on scheudle and rec heparin in right arm. Placed on
heparin gtt after found to beguaic negative (trace positive, no
gross blood, and stable Hct).
.

MEDICAL HISTORY: Onc Hx: Patient presented in [**2185**] with increasing respiratory
infections and with large mediastinal mass leading to SVC
syndrome.  Found to have bulky adenocarcinoma.  Tx with XRT,
carboplatin, Taxol. Followed by Gemcitibine with an almost
complete response. He then took gefitinib for 4 years with no
recurrence of disease. Stopped gefitinib this spring after
discussions with Dr. [**Last Name (STitle) 3274**].Patient has had mult episodes of
SVC syndrome requiring lysis and stenting on 3 occasions from
[**2186**]-[**2187**].  He had been anticoagulated on lovenox.
.
PMH:
- congenital absence of kidney

MEDICATION ON ADMISSION: lovenox 40 mg sc qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:97.5 88 132/69 16 97%
GEN  well, NAD
HEENT PERRL, EOMI, sclera white, mmm, OP clear
NECK supple, FROM, distention of R external jugular veins
CV RRR nlS1-S2 no m/r/g
LUNGS CTA bilaterally
ABD soft NT/D + BS  nl rectal exam with guiac neg stool
RUE: edema, non pitting, 2+pulses, vascular prominence, no
erythema, FROM, in tact sensation  . increased vascular making
extending from R shoulder over the mid chest.
Neuro: CN2-12 intact, [**6-3**] FROM , o x3

FAMILY HISTORY: mGF - lung ca

SOCIAL HISTORY: lives in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] with wife and 3 sons
works in construction/landscaping
no tob, occ etoh, no drugs
former tob > 40 pack years quit [**2185**]
Other complications due to other vascular device, implant, and graft,Personal history of malignant neoplasm of bronchus and lung,Compression of vein
Comp-oth vasc dev/graft,Hx-bronchogenic malignan,Compression of vein
Admission Date:  [**2191-1-6**]              Discharge Date:   [**2191-1-12**]

Date of Birth:  [**2148-10-8**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3276**]
Chief Complaint:
Swollen R arm

Major Surgical or Invasive Procedure:
R arm veinogram

History of Present Illness:
42 M with adeno lung ca, s/p XRT/[**Doctor Last Name **]/taxol, h/o SVC syndrome
with multiple stents, who comes today with right shoulder pain.
He also reports some right finger tip numbness, no lossof
function or strentght. Deneis F/C/chest pain/SOB/N/V.
.
Of note was on lovenox [**Hospital1 **] dosing. This was decreased in
Novermber 13, [**2190**] b/c pt had somehematuria. He notes hematuria
after an erection ,then passes a clot and then normal urine.
Some discomfort but no pain. He had this last 10 days ago. No
BRBRPR or change in stool color.
.
In the ED, VS stable. EKG no changes. CXR clear. IR called who
has pt on scheudle and rec heparin in right arm. Placed on
heparin gtt after found to beguaic negative (trace positive, no
gross blood, and stable Hct).
.


Past Medical History:
Onc Hx: Patient presented in [**2185**] with increasing respiratory
infections and with large mediastinal mass leading to SVC
syndrome.  Found to have bulky adenocarcinoma.  Tx with XRT,
carboplatin, Taxol. Followed by Gemcitibine with an almost
complete response. He then took gefitinib for 4 years with no
recurrence of disease. Stopped gefitinib this spring after
discussions with Dr. [**Last Name (STitle) 3274**].Patient has had mult episodes of
SVC syndrome requiring lysis and stenting on 3 occasions from
[**2186**]-[**2187**].  He had been anticoagulated on lovenox.
.
PMH:
- congenital absence of kidney

Social History:
lives in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] with wife and 3 sons
works in construction/landscaping
no tob, occ etoh, no drugs
former tob > 40 pack years quit [**2185**]


Family History:
mGF - lung ca

Physical Exam:
VS:97.5 88 132/69 16 97%
GEN  well, NAD
HEENT PERRL, EOMI, sclera white, mmm, OP clear
NECK supple, FROM, distention of R external jugular veins
CV RRR nlS1-S2 no m/r/g
LUNGS CTA bilaterally
ABD soft NT/D + BS  nl rectal exam with guiac neg stool
RUE: edema, non pitting, 2+pulses, vascular prominence, no
erythema, FROM, in tact sensation  . increased vascular making
extending from R shoulder over the mid chest.
Neuro: CN2-12 intact, [**6-3**] FROM , o x3


Pertinent Results:
[**2191-1-6**] 05:45PM   GLUCOSE-90 UREA N-16 CREAT-1.1 SODIUM-139
POTASSIUM-3.9 CHLORIDE-104 TOTAL CO2-24 ANION GAP-15
[**2191-1-6**] 05:45PM   WBC-5.2 RBC-4.52* HGB-14.3 HCT-40.2 MCV-89
MCH-31.6 MCHC-35.5* RDW-12.7
[**2191-1-6**] 05:45PM   NEUTS-74.1* LYMPHS-17.1* MONOS-3.1 EOS-5.2*
BASOS-0.5
[**2191-1-6**] 05:45PM   PLT COUNT-183
[**2191-1-6**] 05:45PM   PT-12.2 PTT-28.3 INR(PT)-1.0
_
_
_
_
_
_
_
_
_
_
________________________________________________________________
RADIOLOGY   Preliminary Report

[**Numeric Identifier 97934**] EXTREM UNILAT VENOGRAPHY  [**2191-1-7**] 10:30 AM

Reason: RT SUBCLVIAN STENT OCCLUDED
Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
42 year old man with adenocarcinoma of the lung, h/o SVC
syndromes, multiple stents with right arm pain D rLang's pt
REASON FOR THIS EXAMINATION:
please perform venogram
HISTORY: 42-year-old man with past history of lung cancer and
SVC syndrome. Acute onset of back pain and mild right arm
swelling associated with right arm venous distention.

IMPRESSION: Occlusion of the right subclavian vein stent.
DR. [**First Name8 (NamePattern2) 54747**] [**Name (STitle) **]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **]
PreliminaryApproved: FRI [**2191-1-7**] 6:11 PM
_
_
_
_
_
_
_
________________________________________________________________
   RADIOLOGY   Preliminary Report

UNILAT SUBCLAV  [**2191-1-11**] 9:17 AM

UNILAT SUBCLAV

Reason: please evaluate change in R subclavian thrombus
Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
42 year old man with adenocarcinoma of the lung, h/o SVC
syndromes, multiple stents with right arm pain D rLang's pt
REASON FOR THIS EXAMINATION:
please evaluate change in R subclavian thrombus
INDICATION: 42-year-old man with history of adenocarcinoma of
the lung, status post radiation, history of SVC syndrome with
multiple stents in the right arm. Evaluate for obstruction.

PROCEDURE: The procedure was performed by Dr. [**First Name (STitle) **] [**Name (STitle) **] with
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] present and supervising. 15 cc of contrast was
injected through the sheath in the right arm and a venogram was
obtained. The venogram demonstrates filling and patency of stent
with a tiny residue of clot left.

The patient no longer requires TPA and hence the sheath was
pulled. The patient will be transfused 500 units of heparin per
hour IV peripherally before Lovenox can be started.

IMPRESSION: Tiny residual clot with restoration of flow through
the right subclavian-brachiocephalic stent. TPA discontinued.
The patient to be on heparin before Lovenox can be started.

DR. [**First Name (STitle) 21827**] [**Name (STitle) 21828**]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **]





Brief Hospital Course:
42 M w/ lung ca and SVC syndrom h/o and stents, here with right
shoulder and arm pain.
.

.
1. Right subclavian clot - pt seen by interventional radiology
who recommend lysis with tPA. Pt was monitored in the ICU during
three days of tPA infusion. Repeat veingram showed resolution of
the clot. Clot likely to reform with out adequate
anticoagulation.  This has been limited in the past by
hematuria. Pt was started on enoxaparin 60 mg sc bid. Urology
was consulted who recommended the pt start proscar 5 mg po qd to
help with hematuria. The pt will follow up with urology as an
outpt.
.

Medications on Admission:
lovenox 40 mg sc qd

Discharge Medications:
1. Enoxaparin 60 mg/0.6mL Syringe Sig: Sixty (60) mg
Subcutaneous Q12H (every 12 hours).
Disp:*60 syringe* Refills:*2*
2. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Right subclavian deep vein thrombosis


Discharge Condition:
good


Discharge Instructions:
Please take all medications as prescribed.
.
Please follow up with [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D. for blood in your
urine as he suggested.

Followup Instructions:
Please call Dr.[**Last Name (STitle) 3274**] at ([**Telephone/Fax (1) 3280**] to arrange follow up.


                             [**First Name8 (NamePattern2) 251**] [**Name8 (MD) **] MD [**MD Number(1) 3282**]

Completed by:[**2191-1-12**]
{'Other complications due to other vascular device, implant, and graft,Personal history of malignant neoplasm of bronchus and lung,Compression of vein'}


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: Swollen R arm

PRESENT ILLNESS: 42 M with adeno lung ca, s/p XRT/[**Doctor Last Name **]/taxol, h/o SVC syndrome
with multiple stents, who comes today with right shoulder pain.
He also reports some right finger tip numbness, no lossof
function or strentght. Deneis F/C/chest pain/SOB/N/V.
.
Of note was on lovenox [**Hospital1 **] dosing. This was decreased in
Novermber 13, [**2190**] b/c pt had somehematuria. He notes hematuria
after an erection ,then passes a clot and then normal urine.
Some discomfort but no pain. He had this last 10 days ago. No
BRBRPR or change in stool color.
.
In the ED, VS stable. EKG no changes. CXR clear. IR called who
has pt on scheudle and rec heparin in right arm. Placed on
heparin gtt after found to beguaic negative (trace positive, no
gross blood, and stable Hct).
.

MEDICAL HISTORY: Onc Hx: Patient presented in [**2185**] with increasing respiratory
infections and with large mediastinal mass leading to SVC
syndrome.  Found to have bulky adenocarcinoma.  Tx with XRT,
carboplatin, Taxol. Followed by Gemcitibine with an almost
complete response. He then took gefitinib for 4 years with no
recurrence of disease. Stopped gefitinib this spring after
discussions with Dr. [**Last Name (STitle) 3274**].Patient has had mult episodes of
SVC syndrome requiring lysis and stenting on 3 occasions from
[**2186**]-[**2187**].  He had been anticoagulated on lovenox.
.
PMH:
- congenital absence of kidney

MEDICATION ON ADMISSION: lovenox 40 mg sc qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:97.5 88 132/69 16 97%
GEN  well, NAD
HEENT PERRL, EOMI, sclera white, mmm, OP clear
NECK supple, FROM, distention of R external jugular veins
CV RRR nlS1-S2 no m/r/g
LUNGS CTA bilaterally
ABD soft NT/D + BS  nl rectal exam with guiac neg stool
RUE: edema, non pitting, 2+pulses, vascular prominence, no
erythema, FROM, in tact sensation  . increased vascular making
extending from R shoulder over the mid chest.
Neuro: CN2-12 intact, [**6-3**] FROM , o x3

FAMILY HISTORY: mGF - lung ca

SOCIAL HISTORY: lives in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] with wife and 3 sons
works in construction/landscaping
no tob, occ etoh, no drugs
former tob > 40 pack years quit [**2185**] 

### Response:
{'Other complications due to other vascular device, implant, and graft,Personal history of malignant neoplasm of bronchus and lung,Compression of vein'}
