CHIEF COMPLAINT: Hemoptysis

PRESENT ILLNESS: The patient is a 58 female with a h/o met breast CA to lung
(RUL), retroperitoneum, and right ureter s/p stent with
recurrent episodes of hemoptysis x 1 week who presented to
[**Hospital3 7571**]Hospital.  She was transferred from [**Hospital **]for further assessment of her hemoptysis.

MEDICAL HISTORY: R breast CA dx [**2175**] s/p mesectomy
L breast CA dx [**2190**] s/p lumpectomy + chemo
Ovarian CA dx [**2191**] s/p TAH+BSO + chemo
Osteoporosis
Asthma

MEDICATION ON ADMISSION: Fosamax
Ativan
Lipitor
Zantac
Neurontin
[**Doctor First Name **]
Advair
Tussinex

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: DISCHARGE PE:
Vitals:  98.0  107  90/47  33  98% 6 liters nasal cannula
Gen: NAD
CVS: RRR
Resp: CTA bilaterally
Abd: soft, ND, NT, NABS
Ext: no cyanosis, cords, or edema.

FAMILY HISTORY: Mother with ovarian cancer.

SOCIAL HISTORY: Lives with her husband and has a son and daughter.  She denied
smoking and drinks EtOH socially.
Secondary malignant neoplasm of lung,Secondary malignant neoplasm of other urinary organs,Personal history of malignant neoplasm of breast,Asthma, unspecified type, unspecified,Personal history of malignant neoplasm of ovary,Osteoporosis, unspecified
Secondary malig neo lung,Sec malig neo urin NEC,Hx of breast malignancy,Asthma NOS,Hx of ovarian malignancy,Osteoporosis NOS
Admission Date:  [**2193-12-2**]              Discharge Date:   [**2193-12-4**]

Date of Birth:  [**2135-6-4**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Iodine; Iodine Containing

Attending:[**First Name3 (LF) 281**]
Chief Complaint:
Hemoptysis

Major Surgical or Invasive Procedure:
Rigid Bronchoscopy with tumor ablation and bleeding coagulation.


History of Present Illness:
The patient is a 58 female with a h/o met breast CA to lung
(RUL), retroperitoneum, and right ureter s/p stent with
recurrent episodes of hemoptysis x 1 week who presented to
[**Hospital3 7571**]Hospital.  She was transferred from [**Hospital **]for further assessment of her hemoptysis.


Past Medical History:
R breast CA dx [**2175**] s/p mesectomy
L breast CA dx [**2190**] s/p lumpectomy + chemo
Ovarian CA dx [**2191**] s/p TAH+BSO + chemo
Osteoporosis
Asthma


Social History:
Lives with her husband and has a son and daughter.  She denied
smoking and drinks EtOH socially.

Family History:
Mother with ovarian cancer.

Physical Exam:
DISCHARGE PE:
Vitals:  98.0  107  90/47  33  98% 6 liters nasal cannula
Gen: NAD
CVS: RRR
Resp: CTA bilaterally
Abd: soft, ND, NT, NABS
Ext: no cyanosis, cords, or edema.

Pertinent Results:
[**2193-12-4**] 05:00AM BLOOD WBC-8.5 RBC-3.66* Hgb-10.7* Hct-32.3*
MCV-88 MCH-29.2 MCHC-33.1 RDW-17.8* Plt Ct-261
[**2193-12-4**] 05:00AM BLOOD PT-12.3 PTT-24.7 INR(PT)-1.1
[**2193-12-4**] 05:00AM BLOOD Glucose-98 UreaN-13 Creat-0.6 Na-138
K-3.6 Cl-99 HCO3-32 AnGap-11
[**2193-12-4**] 05:00AM BLOOD Calcium-8.6 Phos-4.4 Mg-1.8.
.
CHEST (PORTABLE AP)  [**2193-12-3**] 5:05 PM
REASON FOR THIS EXAMINATION:
r/o ptx and pneumomediatinum
INDICATION: Status post rigid bronchoscopy for tumor destruction
- tumor ablation. Evaluate for pneumothorax or
pneumomediastinum.
FINDINGS: AP single view with patient in upright sitting
position has been obtained. There are extensive central
pulmonary infiltrates on the right side, a lesser degree also in
the central portion of the left lung. In addition, multiple
round densities are disseminated in both lungs and suggest the
possibility of secondary metastatic deposits. There is no
evidence of pneumothorax or pneumomediastinum on this single AP
view chest examination. A chest CT was performed earlier during
the same day, but previous chest examinations are not available
so that direct comparison can be performed.
.
CT CHEST W/CONTRAST  [**2193-12-3**] 12:36 AM
[**Hospital 93**] MEDICAL CONDITION:
58 year old woman with questionable RUL mass with h/o hemoptysis

REASON FOR THIS EXAMINATION:
eval RUL mass
INDICATION: Hemoptysis. Questionable right upper lobe mass.
History of breast cancer.

No prior chest radiographs or chest CT scans are available for
comparison. Comparison is made to CT abdomen of [**2191-3-2**].

Multidetector CT of the chest was performed following
intravenous administration of 65 cc of Optiray. Images were
presented for display in the axial plane at 5 mm and 1.25 mm
collimation.

Numerous bilateral pulmonary nodules are present involving all
lobes of both lungs. These range in size from less than 1 cm to
several cm in diameter. On thin section images, the vast
majority of the nodules have spiculated and lobulated margins.
Though most of the lesions measure less than 3 cm in diameter, a
dominant mass in the lateral segment right middle lobe measures
3.1 cm x 2.4 cm (image 139, series 102). In addition to the
multiple nodules and mass, there are multilobar areas of
ground-glass attenuation within the lungs as well as
geographically marginated areas of consolidation in the
perihilar and paramediastinal portions of the lungs, worse on
the right than the left. Inferiorly, below the level of the
right hilum, the geographically marginated opacities traverse
the fissure in an non-anatomic distribution that is suggestive
of radiation therapy pneumonitis. However, at a higher level,
the opacities are sharply demarcated by the fissure. Additional
findings include smooth septal thickening with diffuse
distribution but most pronounced in the lower lobes and lung
apices, right greater than left. Thickening is present along the
walls of the central airways, particularly the bronchus
intermedius and right upper lobe bronchi posteriorly.

Bilateral hilar lymphadenopathy is present. Additionally, there
are several prominent right paratracheal lymph nodes measuring
less than 1 cm in greatest short axis dimension, which do not
meet strict criteria for enlargement. The heart size is normal.
A small pericardial effusion is present. Small right pleural
effusion is present as well.

In the imaged portion of the upper abdomen, extrarenal pelves
are present bilaterally in the kidneys. Adrenal glands are
stable in appearance compared to the prior CT abdomen study with
no evidence of suspicious lesions to suggest adrenal metastases.
Heterogeneous appearance of the spleen is likely due to phase of
contrast. Please note that the examination was not specifically
tailored for evaluating the abdominal organs.

There has been prior right mastectomy.

Skeletal structures demonstrate several healed right rib
fractures with marked callus formation. Healing or healed lower
left rib fractures are also noted.

IMPRESSION:
1. Multiple bilateral pulmonary nodules with spiculated and
lobulated margins. Dominant 3.1 cm mass in right middle lobe
with similar morphology to other lesions. In a patient with
history of breast cancer, this may be due to widespread
metastatic disease. Primary lung cancer with metastatic lesions
and diffuse fungal infection are considered less likely.
2. Extensive areas of consolidation with geographic margins in
the perihilar and paramediastinal portions of both lungs. Some
of these traverse the fissure and could potentially reflect
radiation pneumonitis, but coexisting infection, hemorrhage, or
cryptogenic organizing pneumonia is also possible. Correlation
with the portal would be helpful.
3. Multifocal ground-glass opacities and septal thickening.
Differential diagnosis includes interstitial pulmonary edema,
drug toxicity, pulmonary hemorrhage, and lymphangitic
carcinomatosis.
4. Small pericardial effusion.
5. Bilateral hilar lymphadenopathy and borderline right
paratracheal lymph nodes.
6. If available, direct comparison to prior CT scans would be
helpful to determine change from prior exams.

Brief Hospital Course:
The patient is a 58 female with a h/o met breast CA to lung
(RUL), retroperitoneum, and right ureter s/p stent with
recurrent episodes of hemoptysis x 1 week who presented to
[**Hospital3 7571**]Hospital. She was transferred to Dr.[**Name (NI) 1816**]
[**Name (STitle) 1092**] Surgery Service at the [**Hospital1 1170**] from [**Hospital3 7571**]for further assessment of her
hemoptysis on [**2193-12-2**].  She underwent a rigid bronchoscopy on
HD 2 ([**2193-12-3**]) which demonstrated friable mucosa and RUL and
RLL bleeding which was coagulated.  For details of the
operation, please refer to the operative report.  Her
postoperative course has been uncomplicated.
.
On POD 1, she was afebrile and stable.  She has had no episodes
of hemoptysis since admission to the [**Hospital1 827**].  She continued to tolerate a regular diet and
has intermittently had coughing episodes for which she has been
given codeine for.  She was deemed stable for discharge home and
has elected to go home first before deciding on hospice care.
She has been instructed to follow-up with her primary care
physician [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] to setup hospice care.  An appointment
scheduled for [**2193-12-5**] at 2:30PM has been made for her with her
primary care physician.  [**Name10 (NameIs) **] will also be discharged home on her
oxygen as she has been on previously.

Medications on Admission:
Fosamax
Ativan
Lipitor
Zantac
Neurontin
[**Doctor First Name **]
Advair
Tussinex

Discharge Medications:
1. Codeine Phosphate 30 mg Tablet, Soluble Sig: One (1) Tablet,
Soluble PO every six (6) hours as needed for cough.
Disp:*30 Tablet, Soluble(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Metastatic breast Cancer
Ovarian Cancer
Osteoporosis
Asthma


Discharge Condition:
Stable


Discharge Instructions:
Call your primary care physician's ffice if you experience chest
pain, shortness of breath, fever, chills, redness or drainage
form your surgical incisions.

Please resume your previous medications as precribed and the
codeine medication as newly prescribed.

Followup Instructions:
Scheduled Appointments :
Provider [**Name9 (PRE) **],[**First Name3 (LF) **] [**Name Initial (PRE) **]. GYN ONC PPS (SB) Date/Time:[**2194-5-1**] 11:00

Please follow-up with your PCP, [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], on [**2193-12-5**] at
2:30PM. Please coordinate with you PCP for hospice care as
discussed.

Appointments to be made:
Please follow-up with your pulmonologists.


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 286**]
{'Secondary malignant neoplasm of lung,Secondary malignant neoplasm of other urinary organs,Personal history of malignant neoplasm of breast,Asthma, unspecified type, unspecified,Personal history of malignant neoplasm of ovary,Osteoporosis, unspecified'}


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: Hemoptysis

PRESENT ILLNESS: The patient is a 58 female with a h/o met breast CA to lung
(RUL), retroperitoneum, and right ureter s/p stent with
recurrent episodes of hemoptysis x 1 week who presented to
[**Hospital3 7571**]Hospital.  She was transferred from [**Hospital **]for further assessment of her hemoptysis.

MEDICAL HISTORY: R breast CA dx [**2175**] s/p mesectomy
L breast CA dx [**2190**] s/p lumpectomy + chemo
Ovarian CA dx [**2191**] s/p TAH+BSO + chemo
Osteoporosis
Asthma

MEDICATION ON ADMISSION: Fosamax
Ativan
Lipitor
Zantac
Neurontin
[**Doctor First Name **]
Advair
Tussinex

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: DISCHARGE PE:
Vitals:  98.0  107  90/47  33  98% 6 liters nasal cannula
Gen: NAD
CVS: RRR
Resp: CTA bilaterally
Abd: soft, ND, NT, NABS
Ext: no cyanosis, cords, or edema.

FAMILY HISTORY: Mother with ovarian cancer.

SOCIAL HISTORY: Lives with her husband and has a son and daughter.  She denied
smoking and drinks EtOH socially. 

### Response:
{'Secondary malignant neoplasm of lung,Secondary malignant neoplasm of other urinary organs,Personal history of malignant neoplasm of breast,Asthma, unspecified type, unspecified,Personal history of malignant neoplasm of ovary,Osteoporosis, unspecified'}
