CHIEF COMPLAINT: Left upper quadrant pain.

PRESENT ILLNESS: Mr. [**Known lastname 14779**] is a 48 year old man
with a significant past medical history who presents to his
primary care physician on the day of admission with a one
week history of fever and malaise.  The patient had home
temperatures of 101.0 F., on [**5-7**], which briefly improved
over the next few days; however, then again on [**5-9**], the
patient began feeling poorly with aches and fevers.  Denies
upper respiratory or gastrointestinal symptoms.

MEDICAL HISTORY: 1.  Kidney stones; two prior episodes treated with pain
relief.
2.  Health maintenance including a within normal limits
colonoscopy within the past two years, demonstrating only
hemorrhoids.
3.  Stress test in [**2139-9-6**] for costochondritis type
chest pain which demonstrated at 100% of maximum heart rate
eleven minutes of [**Doctor First Name **] protocol.  The patient stopped for
fatigue with no ischemic EKG changes, within normal limit
hemodynamic response.

MEDICATION ON ADMISSION: 

ALLERGIES: To contrast dye given for prior CT scan.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother status post mastectomy.  Father is
85 years old with a history of a gland removed in his
abdomen.  Brother who is healthy.  Positive coronary artery
disease in his uncles.

SOCIAL HISTORY: The patient works in giftware sales.  No
occupational exposures.  No tobacco.  Drinks a few drinks per
week.  No illicit drugs.  He has two daughters, ages 11 and
18 and a son 26.  He lives with his wife and children.
Unspecified disease of pericardium
Pericardial disease NOS
Admission Date:  [**2140-5-13**]       Discharge Date:  [**2140-5-17**]

Date of Birth:   [**2091-8-28**]       Sex:  M

Service:  CCU

CHIEF COMPLAINT:   Left upper quadrant pain.

HISTORY OF PRESENT ILLNESS:   Mr. [**Known lastname 14779**] is a 48 year old man
with a significant past medical history who presents to his
primary care physician on the day of admission with a one
week history of fever and malaise.  The patient had home
temperatures of 101.0 F., on [**5-7**], which briefly improved
over the next few days; however, then again on [**5-9**], the
patient began feeling poorly with aches and fevers.  Denies
upper respiratory or gastrointestinal symptoms.

The day prior to admission, the patient did note some slight
stomach ache with some dry heaves.  On the morning of
admission, he had worsening malaise.  The patient noted an
episode of sharp upper left quadrant pain exacerbated by
laying on his left side, after which the patient said he had
feelings of being slightly nauseated and anxious and as he
was walking to the bathroom, fell to the floor.  The patient
denies trauma.  He had brief loss of consciousness, no
confusion, no incontinence.

After this episode, the patient went to see his primary care
physician, [**Last Name (NamePattern4) **]. [**First Name (STitle) 679**], and was found to have hematuria in the
office and was referred to the Emergency Room.

In the Emergency Room, the patient underwent an abdominal CT
scan and was noted to have a large pericardial effusion.  He
underwent further evaluation for this finding by
echocardiogram which demonstrated tamponade physiology.  The
patient was brought to the Cardiac Catheterization Laboratory
for emergent pericardiocentesis which was performed, and 450
cc. of bloody fluid removed, with suction bulb drain left in
place.  The patient was noted to have hemodynamics including
pulmonary artery pressure of 26/15 with a wedge of 15, right
atrium 13, right ventricle 25/9.  Cardiac output 2.7 with an
index of 1.5, which improved to a cardiac index of 2.4 after
removal of fluid.

Of note, the patient denies any history of chest pain; no
shortness of breath and reports stable recent exercise
tolerance for which at baseline he is able to walk flights of
stairs without limitations.

The patient denies prior tuberculosis exposure and has no
risk factors.  He has no travel history.  The patient does
note sick contacts with his wife and daughter.

PAST MEDICAL HISTORY:
1.  Kidney stones; two prior episodes treated with pain
relief.
2.  Health maintenance including a within normal limits
colonoscopy within the past two years, demonstrating only
hemorrhoids.
3.  Stress test in [**2139-9-6**] for costochondritis type
chest pain which demonstrated at 100% of maximum heart rate
eleven minutes of [**Doctor First Name **] protocol.  The patient stopped for
fatigue with no ischemic EKG changes, within normal limit
hemodynamic response.

MEDICATIONS:  None.  Occasional Tylenol, Motrin,  Sudafed.

FAMILY HISTORY:   Mother status post mastectomy.  Father is
85 years old with a history of a gland removed in his
abdomen.  Brother who is healthy.  Positive coronary artery
disease in his uncles.

SOCIAL HISTORY:   The patient works in giftware sales.  No
occupational exposures.  No tobacco.  Drinks a few drinks per
week.  No illicit drugs.  He has two daughters, ages 11 and
18 and a son 26.  He lives with his wife and children.

ALLERGIES:  To contrast dye given for prior CT scan.

REVIEW OF SYSTEMS;  No vision changes, no upper respiratory
system symptoms; positive slight nausea, positive sharp left
upper quadrant pain; no diarrhea; no constipation.  No
melena, no bright red blood, no urinary frequency, no burning
or frank hematuria.  No rashes, no joint pain, no weight
loss.  The patient reports a stable weight of 133.  Night
sweats only with fevers.

Of note, the patient does report two prior febrile illnesses
in [**Month (only) 1096**] and [**Month (only) 956**] of the past year with five to six
days of fevers and aches.

PHYSICAL EXAMINATION:   Temperature 100.5 F.; blood pressure
111/59; pulse 101; respiratory rate 22; O2 saturation 98% on
room air.  In general, pleasant middle aged man lying in bed
in no acute distress.  HEENT:  Normocephalic, atraumatic.
Pupils are equal, round and reactive to light.  Extraocular
muscles are intact.  Oropharynx with white coating on tongue.
Throat clear, no exudates.  Neck supple, no jugular venous
distention, no anterior or posterior supraclavicular,
axillary or left inguinal lymphadenopathy.  Cardiovascular is
regular rate, no murmur.  Positive tachycardia.  Pulmonary is
clear to auscultation bilaterally anteriorly.  Abdomen is
normoactive bowel sounds, soft, nondistended,  Liver:
Nontender, palpable 2 centimeters below the costal margin.
Spleen not palpable with minimal epigastric left upper
quadrant tenderness.  Extremities with no edema.
Neurological is alert, oriented and appropriate.  Non-focal.

LABORATORY:  White blood cell count 18.3, hematocrit 42.6,
platelets 448.  Sodium 143, potassium 4.7, chloride 101,
bicarbonate 27, BUN 21, creatinine 1.2, glucose 115.  ALT 45,
AST 31, alkaline phosphatase 69, total bilirubin 2.2.
Albumin 4.2, amylase 69, lipase 27.

Urinalysis with large blood, 30 protein, 18 ketones, 6 to 10
red blood cells, zero to 2 white blood cells, 3 bacteria.

Abdominal CT scan demonstrated moderate to large pericardial
effusion.  Pericholecystic fluid, no gallstones; renal stones
without obstruction.

EKG is sinus tachycardia at 115, low voltage, atrial
abnormality.

HOSPITAL COURSE:   Mr. [**Known lastname 14779**] was admitted to the Coronary
Care Unit after successful drainage of his pericardial
effusion.  He was monitored over the next 40 hours and
remained hemodynamically stable.  Repeat echocardiogram
demonstrated his effusion has improved to small and he had
minimal output from his drain.

The etiology of the patient's event remained unclear.  Likely
possibilities included viral illness and virus studies were
pending at time of discharge.  Bacterial Gram stain was
negative and culture negative.  No fungal isolates were
identified.

The patient underwent work-up for a possible malignant
etiology including chest and abdominal CT scans which were
unremarkable for mass.  His PSA was within normal limits.  He
has had a colonoscopy within the past two years which was
normal.

Further infectious work-ups included investigation for
tuberculosis.  The patient received pre-treatment for CT scan
with Prednisone and therefore PPD placement was deferred to
an outpatient setting.  The patient was instructed to follow
with Dr.[**Name (NI) 16937**] office for a PPD placement.

Further evaluation of the pericardial fluid with adenosine
viaminase studies were requested and pending at time of
discharge.  HIV consent and testing were obtained with the
results pending at time of discharge.

GASTROINTESTINAL:  The patient presented with left upper
quadrant pain and an isolated total bilirubin with normal
fractionation.  His total bilirubin improved to normal on day
after admission.

The patient had a repeat urinalysis which demonstrated
improvement in his hematuria to only trace blood, zero to two
red blood cells.  Urine cytology was pending at time of
discharge.

ENDOCRINE:  The patient had persistent tachycardia and
thyroid function tests were checked and pending at time of
discharge.

DISCHARGE MEDICATIONS:  Indomethacin 50 mg p.o. p.r.n.

DISCHARGE INSTRUCTIONS:
1.  Follow-up appointment with Dr. [**First Name (STitle) 679**] for a PPD later this
week.
2.  Dr. [**First Name (STitle) 679**] on Thursday, [**5-26**], at 09:45 a.m.
3.  Cardiology follow-up with Dr. [**First Name4 (NamePattern1) 7422**] [**Doctor First Name 28796**] on
[**6-9**], at 10:30 a.m. with repeat echocardiogram to be
scheduled prior to this visit.
3.  Infectious Disease Clinic with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]; the
patient to call for an appointment in two to three weeks.

CONDITION ON DISCHARGE:   Good.

DISCHARGE DIAGNOSES:  Pericardial efffusion.


                            [**First Name8 (NamePattern2) 870**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 5219**]

Dictated By:[**Last Name (NamePattern1) 7485**]
MEDQUIST36

D:  [**2140-5-17**]  14:58
T:  [**2140-5-20**]  16:09
JOB#:  [**Job Number 28797**]
{'Unspecified disease of pericardium'}


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: Left upper quadrant pain.

PRESENT ILLNESS: Mr. [**Known lastname 14779**] is a 48 year old man
with a significant past medical history who presents to his
primary care physician on the day of admission with a one
week history of fever and malaise.  The patient had home
temperatures of 101.0 F., on [**5-7**], which briefly improved
over the next few days; however, then again on [**5-9**], the
patient began feeling poorly with aches and fevers.  Denies
upper respiratory or gastrointestinal symptoms.

MEDICAL HISTORY: 1.  Kidney stones; two prior episodes treated with pain
relief.
2.  Health maintenance including a within normal limits
colonoscopy within the past two years, demonstrating only
hemorrhoids.
3.  Stress test in [**2139-9-6**] for costochondritis type
chest pain which demonstrated at 100% of maximum heart rate
eleven minutes of [**Doctor First Name **] protocol.  The patient stopped for
fatigue with no ischemic EKG changes, within normal limit
hemodynamic response.

MEDICATION ON ADMISSION: 

ALLERGIES: To contrast dye given for prior CT scan.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother status post mastectomy.  Father is
85 years old with a history of a gland removed in his
abdomen.  Brother who is healthy.  Positive coronary artery
disease in his uncles.

SOCIAL HISTORY: The patient works in giftware sales.  No
occupational exposures.  No tobacco.  Drinks a few drinks per
week.  No illicit drugs.  He has two daughters, ages 11 and
18 and a son 26.  He lives with his wife and children. 

### Response:
{'Unspecified disease of pericardium'}
