CHIEF COMPLAINT: asymptomatic left chest mass

PRESENT ILLNESS: Ms [**Known lastname 6993**] is a 54 yo woman with a history of Breast cancer.
She has a new erosive mass L chest wall
underneath breast implant, worrisome for recurrence of breast
cancer or a new malignancy. Pt had a CT guided chest wall bx
[**5-5**] with path returned as spindle cell lesion. She denies any
pain, SOB, fever, or other sx at this time. She presents now for
resection.

MEDICAL HISTORY: PMH: bilat invasive DCIS [**2097**], neoadjuvant chemo then bilat
mastectomy w/ reconstruction then chemo and xrt to bilat chest
walls, Right breast T4N3M0 stage IIIC, left breast T1N1M0 stage
IIa, Anemia, Vitamin D deficiency, Seasonal allergies, Mild left
upper extremity lymphedema

MEDICATION ON ADMISSION: arimidex 1mg daily, vit D 5000 u/wk, claritin D prn

ALLERGIES: Penicillin G

PHYSICAL EXAM: Temp 97.9 HR 57 BP121/64 RR18 100% RA
Gen: NAD, AOX3
CV: RRR
Resp: CTAB
Chest: s/p radical resection of left chest wall tumor and
reconstruction. Sutures without erythema.  2 JP drains in place
w/ serosangunious output
Abd: soft, NTND
Ext: No LE edema

FAMILY HISTORY: Aunt with breast cancer

SOCIAL HISTORY: Cigarettes: [x ] never  [ ] ex-smoker   [ ] current
Pack-yrs:____
                       quit: ______
ETOH:       [x ] No   [ ] Yes     drinks/day: _____
Drugs:
Exposure:   [x ] No   [ ] Yes  [ ] Radiation
                     [ ] Asbestos [ ] Other:
Occupation:accountant
Marital Status: [ ] Married  [x ] Single
Lives:          [ ] Alone    [ x] w/ family  [ ] Other:
Other pertinent social history:
Travel history:
Malignant neoplasm of thorax,Other specified forms of effusion, except tuberculous,Acquired coagulation factor deficiency,Acute posthemorrhagic anemia,Unspecified vitamin D deficiency,Pulmonary collapse,Hemorrhage complicating a procedure,Acquired deformity of chest and rib,Other iatrogenic hypotension,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple,Postmastectomy lymphedema syndrome,Postprocedural fever
Malign neopl thorax,Effusion NEC exc tb,Acq coagul factor defic,Ac posthemorrhag anemia,Vitamin D deficiency NOS,Pulmonary collapse,Hemorrhage complic proc,Acq chest deformity,Iatrogenc hypotnsion NEC,Abn react-surg proc NEC,Hx of breast malignancy,Acq absnce breast/nipple,Postmastect lymphedema,Postprocedural fever
Admission Date:  [**2101-6-24**]              Discharge Date:   [**2101-7-4**]

Date of Birth:  [**2046-9-25**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillin G

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
asymptomatic left chest mass

Major Surgical or Invasive Procedure:
[**2101-6-24**]
1. Left radical chest wall resection and reconstruction
    with [**Doctor Last Name 4726**]-Tex mesh.
2. Removal of breast implant.
3. Left exploratory thoracoscopy.

[**2101-6-27**]
Bronchoscopy

[**2101-6-27**]
Right PICC line


History of Present Illness:
Ms [**Known lastname 6993**] is a 54 yo woman with a history of Breast cancer.
She has a new erosive mass L chest wall
underneath breast implant, worrisome for recurrence of breast
cancer or a new malignancy. Pt had a CT guided chest wall bx
[**5-5**] with path returned as spindle cell lesion. She denies any
pain, SOB, fever, or other sx at this time. She presents now for
resection.


Past Medical History:
PMH: bilat invasive DCIS [**2097**], neoadjuvant chemo then bilat
mastectomy w/ reconstruction then chemo and xrt to bilat chest
walls, Right breast T4N3M0 stage IIIC, left breast T1N1M0 stage
IIa, Anemia, Vitamin D deficiency, Seasonal allergies, Mild left
upper extremity lymphedema

PSH: Port placement and removal, Appendectomy, Cesarean section,
Bilat mastectomy w/ reconstruction/implants [**2097**], R breast
implant removal due to erosion



Social History:
Cigarettes: [x ] never  [ ] ex-smoker   [ ] current
Pack-yrs:____
                       quit: ______
ETOH:       [x ] No   [ ] Yes     drinks/day: _____
Drugs:
Exposure:   [x ] No   [ ] Yes  [ ] Radiation
                     [ ] Asbestos [ ] Other:
Occupation:accountant
Marital Status: [ ] Married  [x ] Single
Lives:          [ ] Alone    [ x] w/ family  [ ] Other:
Other pertinent social history:
Travel history:


Family History:
Aunt with breast cancer


Physical Exam:
Temp 97.9 HR 57 BP121/64 RR18 100% RA
Gen: NAD, AOX3
CV: RRR
Resp: CTAB
Chest: s/p radical resection of left chest wall tumor and
reconstruction. Sutures without erythema.  2 JP drains in place
w/ serosangunious output
Abd: soft, NTND
Ext: No LE edema


Pertinent Results:
[**2101-6-24**] 12:12PM   GLUCOSE-108* LACTATE-0.7 NA+-140 K+-2.8*
CL--113*
[**2101-6-24**] 12:12PM   HGB-8.4* calcHCT-25
[**2101-6-24**] 08:00PM   GLUCOSE-160* UREA N-9 CREAT-0.6 SODIUM-138
POTASSIUM-3.7 CHLORIDE-110* TOTAL CO2-19* ANION GAP-13
[**2101-6-24**] 08:00PM   CALCIUM-7.2* PHOSPHATE-3.7 MAGNESIUM-1.7
[**2101-6-24**] 08:00PM   WBC-9.4# RBC-3.82* HGB-11.0* HCT-33.5* MCV-88
MCH-28.8 MCHC-32.8 RDW-14.4

[**2101-6-25**] Cardiac echo :
The left ventricle is not well seen, but seems to have normal
function. The right ventricular cavity may be mildly dilated.
Physiologic mitral regurgitation is seen (within normal limits).
The pulmonary artery systolic pressure could not be determined.
There is no pericardial effusion.

[**2101-6-27**] CXR :
Since [**2101-6-25**], left lower and mid lung consolidation has
worsened and associated with mild-to-moderate left pleural
effusion, while mild-to-moderate right pleural effusion is new.

[**2101-6-30**] CXR:
Surgical changes in left chest wall, with minimal residual air

[**2101-7-1**] Chest CT :
Left c/w resection with large L and small R pleural effusions.
Large simple multiloculated L pleural collections w/o hematoma
or active extrav. No drainable collections at JP drain site.

[**2101-7-4**] LUE US:
No left upper extremity deep venous thrombosis.

Brief Hospital Course:
Ms. [**Known lastname 6993**] was admitted to the hospital and taken to the
Operating Room where she underwent a Left radical chest wall
resection and reconstruction with [**Doctor Last Name 4726**]-Tex mesh,
Removal of breast implant, and Left exploratory thoracoscopy.
She tolerated the procedure well and returned to the SICU in
stable condition.  She remained intubated upon transfer out of
the OR and over the next 2 days she was gradually weaned and
extubated. She received one unit of blood post op for a
hematocrit of 23 and she subsequently remained stable in the 30
range.  Her pain was controlled with a Dilaudid PCA and she
maintained stable hemodynamics and was transferred to the
Surgical floor on post op day #3.

She continued to progress well with ambulation, maintaining
sternal precautions and weaning from oxygen.  Her Surgical JP
drains remained in place and were draining bloody fluid post op.
 Her chest tube was removed on [**2101-6-29**] and a subsequent chest
xray showed minimal para mediastinal air.  Her oxygen
saturations were 96% on room air.

Ms. [**Known lastname 6993**] was evaluated by the nutrition team as her oral
intake was minimal and her transferrin and albumin were low
along with an elevated INR.  They felt that she chronically had
a poor oral intake, spent time with her reviewing high protein
foods and recommended protein supplements.  She realizes that
she has multiple wounds to heal and will try her best to improve
her caloric intake.

On [**2101-7-1**] in the early morning hours, Ms. [**Known lastname 6993**] started
having increasing sainguinous output from her anterior JP drain.
It was notably different in appearance than prior thin
serosainguinous fluid and put out about 500 cc in 8 hours which
is significantly higher than prior. She was made NPO, IVF were
started, and a foley was placed. Her type and screen was updated
and she was cross matched for 4 units. Her INR had been elevated
1.8-2 likely secondary to poor nutritional status. Her
hematocrit was stable 31.2->29.6->29.9. Her PICC was changed out
for a power PICC to facilitate injection of IV contrast. A CT
scan was obtained, significant for multiloculated simple pleural
fluid and axillary superficial simple fluid collection. IP was
consulted to drain the pleural fluid from a left lateral
approach.

Ms.[**Known lastname 6993**] has prior LUE edema from mastectomy. An ultrasound
was performed on [**2101-7-4**] to confirm she had no DVT. This
ultrasound was normal.

Her pain was controlled with Ultram and Tylenol and her
incisions were healing well.  Her JP drains will remain in place
along with oral antibiotics and she will be seen by Dr. [**First Name (STitle) 1022**] next
week.  She will have VNA services for help with drain management
and recording outputs.  She will also follow up with Dr.
[**Last Name (STitle) **] in 2 weeks.

Medications on Admission:
arimidex 1mg daily, vit D 5000 u/wk, claritin D prn


Discharge Medications:
1. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
2. cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q12H (every
12 hours).
Disp:*30 Capsule(s)* Refills:*2*
3. tramadol 50 mg Tablet Sig: One (1) Tablet PO QID (4 times a
day) as needed for pain.
Disp:*100 Tablet(s)* Refills:*0*
4. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. zinc sulfate 220 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
6. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
7. senna 8.6 mg Tablet Sig: Two (2) Tablet PO at bedtime as
needed for constipation.
8. Vitamin D3 5,000 unit Tablet Sig: One (1) Tablet PO once a
week.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Left chest wall tumor.
Acute blood loss anemia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
* You were admitted to the hospital for surgery to remove a mass
on your chest wall.  Dr. [**Last Name (STitle) **] was assisted by Dr. [**First Name (STitle) 1022**]
from the Plastic Surgery service. You've recovered well. You are
now ready for discharge but will still need close follow up by
Dr. [**Last Name (STitle) **] and Dr. [**First Name (STitle) 1022**].
* Continue to use your incentive spirometer 10 times an hour
while awake.
* Check your incisions daily and report any increased redness or
drainage.   Cover the area with a gauze pad if it is draining.
* The 2 JP drains will remain in place and will need to be
emptied daily. The VNA will help you with this.
* Write down the amount of drainage from each tube daily so that
Dr. [**First Name (STitle) 1022**] can see the drainage decrease and decide when to remove
them.
* Your antibiotics will continue until the drains are out.
* Your chest tube dressing may be removed in 48 hours.  If it
starts to drain, cover it with a clean dry dressing and change
it  as needed to keep site clean and dry.
* You will continue to need pain medication once you are home
but you can wean it over a few weeks as the discomfort resolves.
 Make sure that you have regular bowel movements while on
narcotic pain medications as they are constipating which can
cause more problems.  Use a stool softener or gentle laxative to
stay regular.
* No driving over the next 4 weeks.
* Take Tylenol  650 mg every 6 hours in between your Ultram.
* Continue to stay well hydrated and eat well to heal your
incisions
* Shower daily. Wash incision with mild soap & water, rinse, pat
dry
* No tub bathing, swimming or hot tubs until incision healed
* No lotions or creams to incision site
* Walk 4-5 times a day and gradually increase your activity as
you can tolerate.
* You will need to maintain sternal precautions over the next
4-6 weeks while going through the healing process.
  1. Do NOT lift more than 10 lbs for the next 6 weeks.
  2. Do NOT let people pull you by your arms when they are
trying to help you move.
  3. Do NOT reach backwards with your arms.
  4. You may use your arms within a pain free range but avoid
reaching backwards.
  5. You may use your arms when getting out of a bed or chair
but try to keep them close to your sides.
  6. You can bend forward to do things like tie your shoes.
Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 2348**] if you experience:
-Fevers > 101 or chills
-Increased shortness of breath, chest pain or any other symptoms
that concern you.




Followup Instructions:
Department: PLASTIC SURGERY
When: WEDNESDAY [**2101-7-6**] at 4:15 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2477**], MD [**Telephone/Fax (1) 31444**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: WEST [**Hospital 2002**] CLINIC
When: TUESDAY [**2101-7-19**] at 9:30 AM
With: [**Name6 (MD) 1532**] [**Last Name (NamePattern4) 8786**], MD [**Telephone/Fax (1) 3020**]
Building: De [**Hospital1 **] Building ([**Hospital Ward Name 121**] Complex) [**Location (un) **]
Campus: WEST     Best Parking: [**Street Address(1) 592**] Garage

Please report 30 minutes prior to your appointment to the
Radiology Department on the [**Location (un) 470**] of the [**Hospital Ward Name 517**]
Clinical Center for a chest xray.

Department: [**Hospital 2039**] CARE CENTER
When: FRIDAY [**2101-7-29**] at 8:45 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 26**] [**Name8 (MD) **], NP [**Telephone/Fax (1) 88653**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage



Completed by:[**2101-7-4**]
{'Malignant neoplasm of thorax,Other specified forms of effusion, except tuberculous,Acquired coagulation factor deficiency,Acute posthemorrhagic anemia,Unspecified vitamin D deficiency,Pulmonary collapse,Hemorrhage complicating a procedure,Acquired deformity of chest and rib,Other iatrogenic hypotension,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple,Postmastectomy lymphedema syndrome,Postprocedural fever'}


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: asymptomatic left chest mass

PRESENT ILLNESS: Ms [**Known lastname 6993**] is a 54 yo woman with a history of Breast cancer.
She has a new erosive mass L chest wall
underneath breast implant, worrisome for recurrence of breast
cancer or a new malignancy. Pt had a CT guided chest wall bx
[**5-5**] with path returned as spindle cell lesion. She denies any
pain, SOB, fever, or other sx at this time. She presents now for
resection.

MEDICAL HISTORY: PMH: bilat invasive DCIS [**2097**], neoadjuvant chemo then bilat
mastectomy w/ reconstruction then chemo and xrt to bilat chest
walls, Right breast T4N3M0 stage IIIC, left breast T1N1M0 stage
IIa, Anemia, Vitamin D deficiency, Seasonal allergies, Mild left
upper extremity lymphedema

MEDICATION ON ADMISSION: arimidex 1mg daily, vit D 5000 u/wk, claritin D prn

ALLERGIES: Penicillin G

PHYSICAL EXAM: Temp 97.9 HR 57 BP121/64 RR18 100% RA
Gen: NAD, AOX3
CV: RRR
Resp: CTAB
Chest: s/p radical resection of left chest wall tumor and
reconstruction. Sutures without erythema.  2 JP drains in place
w/ serosangunious output
Abd: soft, NTND
Ext: No LE edema

FAMILY HISTORY: Aunt with breast cancer

SOCIAL HISTORY: Cigarettes: [x ] never  [ ] ex-smoker   [ ] current
Pack-yrs:____
                       quit: ______
ETOH:       [x ] No   [ ] Yes     drinks/day: _____
Drugs:
Exposure:   [x ] No   [ ] Yes  [ ] Radiation
                     [ ] Asbestos [ ] Other:
Occupation:accountant
Marital Status: [ ] Married  [x ] Single
Lives:          [ ] Alone    [ x] w/ family  [ ] Other:
Other pertinent social history:
Travel history: 

### Response:
{'Malignant neoplasm of thorax,Other specified forms of effusion, except tuberculous,Acquired coagulation factor deficiency,Acute posthemorrhagic anemia,Unspecified vitamin D deficiency,Pulmonary collapse,Hemorrhage complicating a procedure,Acquired deformity of chest and rib,Other iatrogenic hypotension,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple,Postmastectomy lymphedema syndrome,Postprocedural fever'}
