CHIEF COMPLAINT: Aortic dissection.

PRESENT ILLNESS: This is a 39 year old male with
very good health who presented to an outside hospital on
[**2160-5-22**] with sudden onset of lower back and abdominal pain.
He was found to have a kidney stone and discharged to home.
The patient now presents after CT at [**Last Name (un) 4068**] which
demonstrated an aortic dissection.  The patient notes no
changes in his abdominal pain, no nausea or vomiting.  He has
had a bowel movement today.

MEDICAL HISTORY: Negative.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Negative for aneurysm.

SOCIAL HISTORY: He denies tobacco use but admits to six to
eight "drinks per week" and he denies drug use.  He does ride
a bicycle about 100 miles per week.
Dissection of aorta, abdominal,Thrombocytopenia, unspecified,Other and unspecified coagulation defects,Aneurysm of iliac artery,Unspecified essential hypertension
Dsct of abdominal aorta,Thrombocytopenia NOS,Coagulat defect NEC/NOS,Iliac artery aneurysm,Hypertension NOS
Admission Date: [**2160-5-23**]        Discharge Date: [**2160-5-29**]

Date of Birth:  [**2120-11-7**]        Sex:  M

Service:  VSU


CHIEF COMPLAINT:  Aortic dissection.

HISTORY OF PRESENT ILLNESS:  This is a 39 year old male with
very good health who presented to an outside hospital on
[**2160-5-22**] with sudden onset of lower back and abdominal pain.
He was found to have a kidney stone and discharged to home.
The patient now presents after CT at [**Last Name (un) 4068**] which
demonstrated an aortic dissection.  The patient notes no
changes in his abdominal pain, no nausea or vomiting.  He has
had a bowel movement today.

PAST MEDICAL HISTORY:  Negative.

PAST SURGICAL HISTORY:  Bilateral hernia repair in childhood.

ALLERGIES:  No known drug allergies.

MEDICATIONS:  Clomid 25 mg three times a day.

FAMILY HISTORY:  Negative for aneurysm.

SOCIAL HISTORY:  He denies tobacco use but admits to six to
eight "drinks per week" and he denies drug use.  He does ride
a bicycle about 100 miles per week.

PHYSICAL EXAMINATION:  Vital signs:  99.2; 134/54 after
Esmolol was started intravenous.  Initial blood pressure was
150/65.  Heart rate 78; respirations 17; oxygen saturation 99
percent on room air.  General appearance:  Alert male, in no
acute distress.  Chest:  Heart is regular rate and rhythm
with no murmurs, rubs or gallops.  Chest is clear to
auscultation bilaterally.  Abdomen is flat with bowel sounds
and a bruit which radiates to the groin.  He demonstrates
aortic pulsation.  Rectal was guaiac negative.  Extremities
were without edema or embolic toe changes.  Pulse examination
shows carotids 2 plus palpable.  There are no bruits.  Radial
pulses:  2 plus and symmetric.  Femorals are 2 plus.
Dorsalis pedis and posterior tibial are 2 and 2 plus
bilaterally.

LABORATORY DATA:  White count of 9.8; hematocrit of 42;
platelets 104.  Neutrophils 81; lymphs 11.  BUN 13;
creatinine 0.8.  PT and INR were normal.  Arterial blood
gases 7.40, 40, 106, 26 and zero.  Lactate acid is 1.3.

HOSPITAL COURSE:  The patient was admitted to the Intensive
Care Unit.  He was started on Esmolol and Nipride for blood
pressure control.  Four units of packed red blood cells were
set up for potential operating room.  The patient underwent
CTA which demonstrated infrarenal abdominal aortic aneurysm
with dissection extending from the SMA to the right iliac
artery.  The renal arteries were originating from different
lumens with symmetric enhancement.  The celiac SMA and [**Female First Name (un) 899**]
were patent.  The thoracic aorta was unremarkable.  The
patient remained hemodynamically stable and on [**2160-5-24**],
underwent an auto bifemoral bypass. He tolerated the
procedure well.  He received 2700 cc of cell [**Doctor Last Name 10105**].  He was
transferred to the Surgical Intensive Care Unit for continued
monitoring and care.

On postoperative day, he had a temperature maximum of 102.4.
His white count was 13.0; hematocrit of 38; platelet count of
66K; BUN 9; creatinine 0.9.  Coagulations were normal.
Examination was unremarkable.  He had palpable femoral
posterior tibial and dorsalis pedis bilaterally.  We felt
that the patient's temperature elevation may have been
related to blood products. He was being transfused with FFP
at the time.

The patient continued to be vent dependent on postoperative
day number one.  Blood cultures were obtained.  White count
was 9.7.  The chest x-ray demonstrated some left lower lobe
atelectasis and the blood cultures were no growth but not
finalized at the time of dictation.  The patient's urine
culture was negative.  The Swan-Ganz catheter was changed to
a triple lumen on postoperative day number two.  The patient
continued with a temperature maximum of 101.1 to 37.7.
Nasogastric was discontinued and sips were instituted.  The
patient was continued on Levofloxacin and Flagyl.  His drips
were weaned to tolerate a systolic blood pressure less than
130.  An echo was obtained which demonstrated left atrial
dilatation with left atrial elongation.  The right atrial
intra-atrial septum was markedly dilated.  The left ventricle
showed symmetrical left ventricular hypertrophy.  The left
ventricular size was normal.  There was mild global left
ventricular hypokinesis.  Overall left ventricular function
was mildly depressed. The right ventricle chamber size and
wall motion were normal.  The aorta was mildly dilated with
an ascending aorta normal. Arch was normal in diameter.  The
aortic valve is trileaflet with good excursion.  The mitral
valve was 1 plus mitral regurgitation.  The tricuspid valve
was 1 plus tricuspid regurgitation.  There was mild pulmonary
systolic hypertension.  There was no pericardial effusion.

The patient continued to do well. Cardiology was consulted
regarding consideration that the patient might have Marfan's
and they had no further recommendations except for a
transesophageal echocardiogram but they felt that the CT of
the chest should have ruled out thoracic aortic disease.
Cardiac surgery was also consulted regarding the patient and
they recommended continued blood pressure control.  There was
no operative management indicated in this patient.  Consider
obtaining a MRA of the ascending aortic arch to define the
anatomy.  A MRI/MRA of the chest was obtained which there was
no evidence of aortic dissection.  The ascending aorta
measures 3.7 cm in diameter and the descending aorta measured
2.6 cm in diameter at the level of the pulmonary artery.  The
aorta arch measures 2.9 cm in diameter. There is no evidence
of intramural hematoma. There is noted bilateral pleural
effusions and bilateral lower lung atelectasis.

The patient's platelet count continued to remain depressed
and hematology was consulted.  They felt that the patient's
picture of high PTT and low fibrinogen was consistent with
DIC, which was secondary to consumption of his platelets at
his aneurysm.  They felt that serial monitoring of his
coagulation studies and platelets is recommended and that the
patient, as he clinically improves, will show an improvement
in his platelet count.  No further intervention or work-up
for his thrombocytopenia was indicated.  The patient was
transferred from the Surgical Intensive Care Unit to the VICU
on postoperative day number three.  He was weaned off his
Esmolol.  Ambulation to chair was instituted and diet was
advanced to tolerate.

Postoperative day number four, the patient continued to do
well. His temperature maximum was 100.1 to 98.1.  His lung
examination had diminished breath sounds at the bases,
consistent with his atelectasis.  His incisions were clean,
dry and intact.  He had palpable pedal pulses bilaterally.
His blood pressure was under excellent control with a
systolic blood pressure of 116.  The patient's platelet count
continued to improve with a platelet count of 108K.
Hematology signed off on postoperative day number four.  His
A line was discontinued.  There were no overnight events.  He
was afebrile. His white count was 6.6; hematocrit of 39.0;
platelets of 106K; BUN and creatinine were stable.  His
examination was unremarkable.  Abdomen was soft, nontender,
nondistended.  Incisions were clean, dry and intact.  He had
palpable pedal pulses.  He was converted to oral analgesic
agents.  His intravenous fluids were hep-locked and he was
discharged to home in stable condition.  He will continue on
Lopressor and Percocet for analgesic control.

FOLLOW UP:  He should follow-up with Dr. [**Last Name (STitle) **] in one weeks
time.  He should call the office for an appointment at [**Telephone/Fax (1) 32479**].

DISCHARGE DIAGNOSES:  Abdominal aortic dissection, status
post aorta bifemoral repair.

Thrombocytopenia, secondary to aneurysm, improved.

Hypertension, treated, controlled.





                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 3439**]

Dictated By:[**Last Name (NamePattern1) 2382**]
MEDQUIST36
D:  [**2160-5-29**] 10:14:48
T:  [**2160-5-29**] 10:51:21
Job#:  [**Job Number 32480**]
{'Dissection of aorta, abdominal,Thrombocytopenia, unspecified,Other and unspecified coagulation defects,Aneurysm of iliac artery,Unspecified essential hypertension'}


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: Aortic dissection.

PRESENT ILLNESS: This is a 39 year old male with
very good health who presented to an outside hospital on
[**2160-5-22**] with sudden onset of lower back and abdominal pain.
He was found to have a kidney stone and discharged to home.
The patient now presents after CT at [**Last Name (un) 4068**] which
demonstrated an aortic dissection.  The patient notes no
changes in his abdominal pain, no nausea or vomiting.  He has
had a bowel movement today.

MEDICAL HISTORY: Negative.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Negative for aneurysm.

SOCIAL HISTORY: He denies tobacco use but admits to six to
eight "drinks per week" and he denies drug use.  He does ride
a bicycle about 100 miles per week. 

### Response:
{'Dissection of aorta, abdominal,Thrombocytopenia, unspecified,Other and unspecified coagulation defects,Aneurysm of iliac artery,Unspecified essential hypertension'}
