CHIEF COMPLAINT: hemoptysis associated with new right upper lobe lung mass

PRESENT ILLNESS: 70 year old male with new hemoptysis associated with new RUL
lung mass on [**8-2**].  In [**7-3**], patient complained of RUE/shoulder
pain progressing to slight increase in shortness of breath. On
CXR, RUL lung mass found.  Patient treated with antibiotics for
post obstructive pneumonia on [**8-22**] to [**9-1**].  Patient has had
decreased activity over the past 2 months; can walk one flight
of stairs with resting at the top. Patient was scheduled to see
Dr. [**Last Name (STitle) 952**] at the thoracic clinic.  However, this AM patient
awoke with coughing up blood. Patient brought to [**Hospital3 **]
Hospital and transferred to [**Hospital1 18**].

MEDICAL HISTORY: lung mass; MIx3, stents x2, bronchoscopy [**2131-9-11**]

MEDICATION ON ADMISSION: [**Last Name (LF) 4532**], [**First Name3 (LF) **], toprol 100',percocet,crestor

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ROS
Neuro: Denies blurred vision
Resp: increased SOB, cough, hemoptysis
Cardio: no pedal edema
Abd: no issues
Ext: R. shoulder referred pain

FAMILY HISTORY: n/a

SOCIAL HISTORY: Lives in elderly nursing [**Hospital3 **], widow x 8 yrs, retired
janitor in school, no known occupational exposures, 1.5 ppd
smoker x 55yrs
Malignant neoplasm of upper lobe, bronchus or lung,Old myocardial infarction,Other and unspecified hyperlipidemia
Mal neo upper lobe lung,Old myocardial infarct,Hyperlipidemia NEC/NOS
Admission Date:  [**2131-9-18**]              Discharge Date:   [**2131-9-25**]

Date of Birth:  [**2061-7-25**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern1) 1561**]
Chief Complaint:
hemoptysis associated with new right upper lobe lung mass

Major Surgical or Invasive Procedure:
bronchoscopy
embolization of bronchointercostal trunk

History of Present Illness:
70 year old male with new hemoptysis associated with new RUL
lung mass on [**8-2**].  In [**7-3**], patient complained of RUE/shoulder
pain progressing to slight increase in shortness of breath. On
CXR, RUL lung mass found.  Patient treated with antibiotics for
post obstructive pneumonia on [**8-22**] to [**9-1**].  Patient has had
decreased activity over the past 2 months; can walk one flight
of stairs with resting at the top. Patient was scheduled to see
Dr. [**Last Name (STitle) 952**] at the thoracic clinic.  However, this AM patient
awoke with coughing up blood. Patient brought to [**Hospital3 **]
Hospital and transferred to [**Hospital1 18**].

Past Medical History:
lung mass; MIx3, stents x2, bronchoscopy [**2131-9-11**]

Social History:
Lives in elderly nursing [**Hospital3 **], widow x 8 yrs, retired
janitor in school, no known occupational exposures, 1.5 ppd
smoker x 55yrs

Family History:
n/a

Physical Exam:
ROS
Neuro: Denies blurred vision
Resp: increased SOB, cough, hemoptysis
Cardio: no pedal edema
Abd: no issues
Ext: R. shoulder referred pain

PE
95.7 74 167/62 18 96%RA
GEN: healthy-appearing, elderly male
HEENT: neg. lymphadenopathy (cervical, suprclavicular, axilla)
RESP: CTA B/L
HEART: RRR
ABD: soft, NT/ND
EXT: no edema

Pertinent Results:
[**2131-9-25**] 07:50AM BLOOD WBC-12.1* RBC-4.44* Hgb-12.6* Hct-35.3*
MCV-80* MCH-28.3 MCHC-35.5* RDW-15.4 Plt Ct-373
[**2131-9-25**] 07:50AM BLOOD Plt Ct-373
[**2131-9-25**] 07:50AM BLOOD Glucose-88 UreaN-14 Creat-1.4* Na-140
K-4.1 Cl-105 HCO3-26 AnGap-13
[**2131-9-22**] 03:32AM BLOOD ALT-11 AST-11 LD(LDH)-154 AlkPhos-113
Amylase-49 TotBili-0.4
[**2131-9-25**] 07:50AM BLOOD Calcium-9.3 Phos-3.6 Mg-2.2

Bronchial Washings
[**2131-9-21**]
SPECIMEN RECEIVED: [**2131-9-20**]    [**-6/3307**]    BRONCHIAL WASHINGS

SPECIMEN DESCRIPTION: Received 20ml bloody mucoid fluid.
  Prepared 1 ThinPrep slide.

CLINICAL DATA: Heavy tobacco use with hemoptysis and RUL mass.
REPORT TO: DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Doctor Last Name **]

DIAGNOSIS: NEGATIVE FOR MALIGNANT CELLS.

  Rare epithelial cells, lymphocytes and neutrophils.

[**9-20**] PET CT
INTERPRETATION: There is focal abnormal uptake of FDG in a
cavitary right
apical mass with an SUVmax of 18.1. There is abnormal FDG uptake
in a right
hilar node (SUVmax 8.8) and in the left enlarged adrenal (SUVmax
of 4.21).

There is homogeneously increased FDG uptake in the left
iliopsoas likely due to
biomechanics.
Physiologic uptake is seen in the brain, heart and GI and GU
tracts.

The CT shows vascular calcifications, a left renal cyst (not
FDG-avid; 4.5 cm
diameter), a small right non-FDG-avid cyst and osteophytosis at
numerous spinal
levels.

IMPRESSION: Findings are consistent with a right apical lung
cancer metastatic
to a right hilar lymph node and possibly to the left adrenal
gland.

MRI ABDOMEN W/O CONTRAST  [**2131-9-22**] 5:37 PM
MRI ABDOMEN W/O CONTRAST

Reason: MRI ADRENAL LEFT SIDE ONLY - please eval. for metastatic
lun
INDICATION: Metastatic lung cancer. Evaluate left adrenal
nodule.

TECHNIQUE: Noncontrast adrenal protocol was performed on a 1.5 T
magnet, including in phase and opposed- phased T1 weighted
images, as well as T2- weighted images of the adrenal glands.

FINDINGS: There is nodular thickening of both adrenal glands,
more prominent on the right than on the left. These both show
marked drop of signal on the opposed-phased images, consistent
with intravoxel fat. Visualized portions of the liver, spleen,
and pancreas appear unremarkable allowing for the technique.
Multiple renal cysts are present. There is bibasilar
atelectasis.

IMPRESSION: Bilateral adrenal hyperplasia, left greater than
right. No suspicious adrenal lesions are seen.

MR HEAD W & W/O CONTRAST  [**2131-9-22**] 5:37 PM
MR HEAD W & W/O CONTRAST

Reason: Eval. for brain metastatic disease
Contrast: MAGNEVIST
CLINICAL INFORMATION: Patient with right upper lobe lung cancer
for further evaluation.

TECHNIQUE: T1 sagittal and axial and FLAIR T2 susceptibility and
diffusion axial images were obtained before gadolinium. T1
sagittal, axial and coronal images were obtained following the
administration of gadolinium.

FINDINGS: The ventricles and extra-axial spaces are slightly
prominent but appropriate for patient's age. There is no midline
shift, mass effect or hydrocephalus identified. There is no
evidence of significant subcortical white matter ischemic
disease or acute infarct seen.

Following gadolinium no evidence of abnormal parenchymal,
vascular or meningeal enhancement identified. Small retention
cysts are seen in the left maxillary sinus.

IMPRESSION: No enhancing intracranial lesions are identified or
mass effect is seen.

CHEST (PA & LAT)  [**2131-9-24**] 8:25 PM
CHEST (PA & LAT)
Reason: eval for consolidation.pna

HISTORY: Right upper lobe mass and elevated white count.

IMPRESSION: PA and lateral view compared to [**9-20**]:

Infiltration surrounding the cavitary lesion in the right lung
apex has improved revealing the multi-cameral quality of the
lesion and local pleural thickening.

Lung volumes are lower and there is interstitial abnormality at
the right base exaggerated by overlying soft tissue. This could
be early pneumonia or, under the appropriate circumstances, drug
reaction. I would recommend a repeat frontal view of maximal
inspiration to see if this is a real or an artifactual finding.

Heart size is normal. There is no pleural effusion.


Brief Hospital Course:
Patient was admitted to thoracic surgery.  OSH results include
only a BAL: AFB neg., rare aspergillis. On HD2, bronchoscopy
showed scant bleeding from posterior segment of RUL; cytology
sent and no malignant cells found. On HD3 PET showed focal
abnormal uptake of FDG in a cavitary right apical mass, abnormal
FDG uptake in a right hilar node and in the left enlarged
adrenal gland. Patient then transferred to ICU because of 200c
hemoptysis on the floor.  ID consulted to rule out TB.  On HD4,
patient had embolization of bronchointercostal trunk, via rt
transfem approach.  On HD5, patient was hemodynamically stable
and transferred to the floor.  Patient had MRI of the head and
abdomen which showed b/l adrenal hyperplasia, left greater than
right. No suspicious adrenal lesions are seen.  Patient had
negative AFB cultures, remained afebrile, and hemodynamically
stable. On HD8, patient was discharged back to the assisted care
facility.


Medications on Admission:
[**Last Name (LF) 4532**], [**First Name3 (LF) **], toprol 100',percocet,crestor

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*
2. Metoprolol Succinate 100 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
3. Rosuvastatin 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).


Discharge Disposition:
Home

Discharge Diagnosis:
right upper lobe lesion


Discharge Condition:
good


Discharge Instructions:
Call Dr.[**Name (NI) 1816**] office [**Telephone/Fax (1) 170**] or your own pulmonologist
if you develop fever, chills, shortness of breath, chest pain.

call you cardiologist at home for a follow up appointment.

Followup Instructions:
Dr. [**First Name4 (NamePattern1) 951**] [**Last Name (NamePattern1) **] office [**Telephone/Fax (1) 170**]. Call for undate
regarding surgery week of [**2131-10-2**].
Cardiac evaluation prior to surgery by Dr [**Last Name (STitle) 69253**] [**Name (STitle) 69254**] office,
[**Location (un) 9101**], [**Telephone/Fax (1) 34149**]. They have been informed of this and will
call to arrange tests prior to surgery.
{'Malignant neoplasm of upper lobe, bronchus or lung,Old myocardial infarction,Other and unspecified hyperlipidemia'}


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 associated with new right upper lobe lung mass

PRESENT ILLNESS: 70 year old male with new hemoptysis associated with new RUL
lung mass on [**8-2**].  In [**7-3**], patient complained of RUE/shoulder
pain progressing to slight increase in shortness of breath. On
CXR, RUL lung mass found.  Patient treated with antibiotics for
post obstructive pneumonia on [**8-22**] to [**9-1**].  Patient has had
decreased activity over the past 2 months; can walk one flight
of stairs with resting at the top. Patient was scheduled to see
Dr. [**Last Name (STitle) 952**] at the thoracic clinic.  However, this AM patient
awoke with coughing up blood. Patient brought to [**Hospital3 **]
Hospital and transferred to [**Hospital1 18**].

MEDICAL HISTORY: lung mass; MIx3, stents x2, bronchoscopy [**2131-9-11**]

MEDICATION ON ADMISSION: [**Last Name (LF) 4532**], [**First Name3 (LF) **], toprol 100',percocet,crestor

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ROS
Neuro: Denies blurred vision
Resp: increased SOB, cough, hemoptysis
Cardio: no pedal edema
Abd: no issues
Ext: R. shoulder referred pain

FAMILY HISTORY: n/a

SOCIAL HISTORY: Lives in elderly nursing [**Hospital3 **], widow x 8 yrs, retired
janitor in school, no known occupational exposures, 1.5 ppd
smoker x 55yrs 

### Response:
{'Malignant neoplasm of upper lobe, bronchus or lung,Old myocardial infarction,Other and unspecified hyperlipidemia'}
