CHIEF COMPLAINT: Left flank pain

PRESENT ILLNESS: The patient is a 78 year old male who presented to the ED with
the chief complaint of [**9-23**] left flank pain. The patient had a
UA which showed large blood and [**12-3**] RBCs. He had a CT of his
abdomen and pelvis. In addition, for unclear reasons, the
patient had a [**Name (NI) 16992**] in the ED which was mildly elevated at 558
and thus underwent a CTA to rule out PE. His CTA was negative
for PE but coincidentally showed the following: 6.0 x 3.4 x 4.0
cm intracardiac enhancing mass within the right ventricular
outflow tract. This finding is new since the prior CT torso of
[**2185-3-16**]. Cardiology and CT surgery were consulted in the ED. Of
note, the patient has a history of a sinus of Valsalva aneurysm
first noted on an echo in [**2182**].

MEDICAL HISTORY: h/o prostate cancer s/p XRT
Epidermal inclusion cysts
Right inguinal hernia s/p repair in [**2183**]
Emphysema, negative smoking history
Osteoporosis

MEDICATION ON ADMISSION: Flomax 0.4 mg PO QD
Fosamax  70 mg PO QSunday
MVI
Calcium

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tc = 98.1 P=71 BP=115/58 (115-151) RR=18  97% on RA
Gen - NAD, AOX3, pleasant Caucasian male, knees flexed
HEENT - facial erythema over malar eminence and over nasal
bridge, mild telengiectasias, no oral lesions, MMM, JVD with
prominent V wave to 8-10 cm, right carotid bruit ?, none on left
Heart - RRR, Grade III/VI holosystolic harsh murmur over left
sternal border radiating throughout the precordium. No S3, S4.
Non-displaced PMI.
Lungs - CTAB
Abdomen - Voluntary guarding with arm over RUQ, knees flexed, no
rebound/guarding but extremely tender at RUQ and periumbilicus,
no pulsatile masses, no bruits, incompletely evaluated liver
edge given tenderness, no palpable inguinal hernia on left
Back - No CVAT bilaterally
Ext - No C/C/E, +2. d. pedis, no femoral bruits +2 femoral
pulses
Skin - As noted facial erythema with telengiectasias, otherwise
no rashes

FAMILY HISTORY: Father deceased at 71 from MI
Mother died suddenly
Brother deceased at 70 from MI

SOCIAL HISTORY: The patient lives alone in a 1 story apartment. He is
independent with his own ADLs. He drinks on occasion on the
weekends but denies any smoking history. His father and brother
were heavy smokers.
Aneurysm of heart (wall),Peripheral vascular complications, not elsewhere classified,Hematoma complicating a procedure,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, Stage II (mild),Aneurysm of artery of lower extremity,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Personal history of malignant neoplasm of prostate,Personal history of irradiation, presenting hazards to health,Osteoporosis, unspecified,Other chronic pulmonary heart diseases,Family history of ischemic heart disease,Calculus of kidney,Other nonspecific abnormal serum enzyme levels
Aneurysm of heart,Surg comp-peri vasc syst,Hematoma complic proc,Chr airway obstruct NEC,Chro kidney dis stage II,Lower extremity aneurysm,Abn react-cardiac cath,Hx-prostatic malignancy,Hx of irradiation,Osteoporosis NOS,Chr pulmon heart dis NEC,Fam hx-ischem heart dis,Calculus of kidney,Abn serum enzy level NEC
Admission Date:  [**2187-4-8**]              Discharge Date:   [**2187-4-13**]

Date of Birth:  [**2108-10-11**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Left flank pain

Major Surgical or Invasive Procedure:
Repair of right femoral artery pseudoaneurysm
Cardiac Catheterization

History of Present Illness:
The patient is a 78 year old male who presented to the ED with
the chief complaint of [**9-23**] left flank pain. The patient had a
UA which showed large blood and [**12-3**] RBCs. He had a CT of his
abdomen and pelvis. In addition, for unclear reasons, the
patient had a [**Name (NI) 16992**] in the ED which was mildly elevated at 558
and thus underwent a CTA to rule out PE. His CTA was negative
for PE but coincidentally showed the following: 6.0 x 3.4 x 4.0
cm intracardiac enhancing mass within the right ventricular
outflow tract. This finding is new since the prior CT torso of
[**2185-3-16**]. Cardiology and CT surgery were consulted in the ED. Of
note, the patient has a history of a sinus of Valsalva aneurysm
first noted on an echo in [**2182**].

Past Medical History:
h/o prostate cancer s/p XRT
Epidermal inclusion cysts
Right inguinal hernia s/p repair in [**2183**]
Emphysema, negative smoking history
Osteoporosis

Social History:
The patient lives alone in a 1 story apartment. He is
independent with his own ADLs. He drinks on occasion on the
weekends but denies any smoking history. His father and brother
were heavy smokers.

Family History:
Father deceased at 71 from MI
Mother died suddenly
Brother deceased at 70 from MI

Physical Exam:
Tc = 98.1 P=71 BP=115/58 (115-151) RR=18  97% on RA
Gen - NAD, AOX3, pleasant Caucasian male, knees flexed
HEENT - facial erythema over malar eminence and over nasal
bridge, mild telengiectasias, no oral lesions, MMM, JVD with
prominent V wave to 8-10 cm, right carotid bruit ?, none on left
Heart - RRR, Grade III/VI holosystolic harsh murmur over left
sternal border radiating throughout the precordium. No S3, S4.
Non-displaced PMI.
Lungs - CTAB
Abdomen - Voluntary guarding with arm over RUQ, knees flexed, no
rebound/guarding but extremely tender at RUQ and periumbilicus,
no pulsatile masses, no bruits, incompletely evaluated liver
edge given tenderness, no palpable inguinal hernia on left
Back - No CVAT bilaterally
Ext - No C/C/E, +2. d. pedis, no femoral bruits +2 femoral
pulses
Skin - As noted facial erythema with telengiectasias, otherwise
no rashes

Pertinent Results:
CXR [**4-8**]: Severe emphysema. No evidence of pneumonia.
CTA CHEST [**4-8**]: 6.0 x 3.4 x 4.0 cm intracardiac enhancing mass
within the right ventricular outflow tract. This finding is new
since the prior CT torso of [**2185-3-16**]. Most likely this represents
a tumor such as myxoma, rather than a thrombus, and
echocardiography or MR is recommended for further
characterization.
Echo [**4-9**]: Overall left ventricular systolic function is normal
(LVEF>55%). The right ventricular cavity is dilated. There is a
right coronary sinus of Valsalva aneurysm 5.3 x 4.5 cm. The
cavity has echodense material within it consistent with 'smoke',
which suggests low flowing blood. The aortic valve leaflets (3)
are mildly thickened. Moderate to severe ([**2-16**]+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Mild (1+) mitral regurgitation is seen. Moderate [2+]
tricuspid regurgitation is seen. There is moderate pulmonary
artery systolic hypertension. There is a moderately severe
stenosis at the level of the RV outflow tract created by the
bulging Sinus of Valsalva aneurysm with a peak gradient of
47mmHg.
Cath [**4-9**]: Selective coronary angiography of this right dominant
system demonstrated no angiographic evidence of any significant
atherosclerotic lesions. Specifically the left main demonstrated
an ostial 40% lesion along with an diffuse 30% distal vessel
plaquing. The LAD was moderately calcified with TIMI III flow
throughout the vessel. The LCX demonstrated proximal 30%
stenosis. The RCA had an ostial 30% lesion along with proximal
40% lesion. Limited resting hemodynamics demonstrated a normal
central pressure (119/47 mm Hg).
[**2187-4-8**] 08:00AM BLOOD WBC-6.5 RBC-4.23* Hgb-13.7* Hct-40.2
MCV-95 MCH-32.3* MCHC-34.0 RDW-13.7 Plt Ct-286
[**2187-4-12**] 03:54AM BLOOD WBC-7.9 RBC-3.34*# Hgb-10.8* Hct-30.9*
MCV-93 MCH-32.5* MCHC-35.1* RDW-16.3* Plt Ct-170
[**2187-4-9**] 09:25AM BLOOD PT-15.0* INR(PT)-1.3*
[**2187-4-12**] 03:54AM BLOOD PT-14.8* PTT-26.1 INR(PT)-1.3*
[**2187-4-8**] 02:47PM BLOOD D-Dimer-558*
[**2187-4-8**] 08:00AM BLOOD Glucose-95 UreaN-26* Creat-1.0 Na-143
K-3.7 Cl-105 HCO3-27 AnGap-15
[**2187-4-12**] 03:54AM BLOOD Glucose-122* UreaN-13 Creat-0.9 Na-137
K-3.8 Cl-109* HCO3-20* AnGap-12
[**2187-4-10**] 07:45AM BLOOD ALT-12 AST-24 LD(LDH)-148 AlkPhos-76
Amylase-226* TotBili-0.5
[**2187-4-12**] 03:54AM BLOOD Calcium-7.8* Phos-2.5* Mg-1.5*
[**2187-4-11**] 07:12PM BLOOD freeCa-1.20
[**2187-4-8**] 08:00AM URINE RBC-[**12-3**]* WBC-0 Bacteri-RARE Yeast-NONE
Epi-0
[**2187-4-8**] 08:00AM URINE Blood-LG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG

Brief Hospital Course:
Following admission, as mentioned in the HPI, cardiology and
cardiac surgery consulted on patient. On [**4-9**] Mr. [**Known lastname 107677**] [**Last Name (Titles) 8783**]t both Echo and cardiac cath. Both studies revealed
sinus of Valsalva aneurysm (see pertinent results). Patient then
consented to surgical repair of the aneurysm and was brought to
the operating room on [**4-11**]. After intubating patient, Mr.
[**Known lastname 107677**] was found to have a right groin pulsatile mass. U/S was
performed in OR and found a pseudoaneurysm of his right common
femoral artery (at region of cath site). Vascular surgery was
immediately consulted. Patients family was made aware and
consented him for surgical repair of pseudoaneurysm. Repair of
his sinus of Valsalva aneurysm was delayed. He was transferred
to CSRU post-operatively. On same day sedation was weaned, he
awoke neurologically intact, and was extubated. He was
transferred to the cardiac surgery step-down unit on post-op day
1. Vascular continued to follow patient throughout hospital
course. Physical therapy followed patient post-operatively for
strength and mobility. He was cleared for home on post-op day 2.
He will follow-up with Dr. [**Last Name (STitle) **] as an outpatient and will
have the repair of his sinus of Valsalva aneurysm done shortly
(will be contact[**Name (NI) **] next week).

Medications on Admission:
Flomax 0.4 mg PO QD
Fosamax  70 mg PO QSunday
MVI
Calcium

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
4. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24HR(s)* Refills:*0*
5. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Sinus of Valsalva Aneurysm
Pseudoaneurysm right femoral artery s/p repair
Chronic Obstructive Pulmonary Disease
Prostate Cancer s/p XRT [**11/2177**]
Osteoporosis
Epidermal Inlusion cysts
s/p R Inguinal Hernia Repair

Discharge Condition:
Good

[**Last Name (NamePattern4) **]ge Instructions:
[**Month (only) 116**] take shower. Wash right groin incision with water and gentle
soap. Gently pat dry. Do not apply lotions, creams, ointments,
or powders to incision. Do not bath or swim.
If you develop a fever more than 101.5 or develop drainage from
incision, please contact office ([**Telephone/Fax (1) 170**]).
Dr. [**Last Name (STitle) **] [**Last Name (Prefixes) 2546**] office will contact you next week regarding
new surgical date.
Call physician below to schedule appointment in 10 days.

Followup Instructions:
Dr. [**Last Name (STitle) **] (vascular) at [**Telephone/Fax (1) 3121**] in 10 days


Completed by:[**2187-4-13**]
{'Aneurysm of heart (wall),Peripheral vascular complications, not elsewhere classified,Hematoma complicating a procedure,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, Stage II (mild),Aneurysm of artery of lower extremity,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Personal history of malignant neoplasm of prostate,Personal history of irradiation, presenting hazards to health,Osteoporosis, unspecified,Other chronic pulmonary heart diseases,Family history of ischemic heart disease,Calculus of kidney,Other nonspecific abnormal serum enzyme levels'}


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 flank pain

PRESENT ILLNESS: The patient is a 78 year old male who presented to the ED with
the chief complaint of [**9-23**] left flank pain. The patient had a
UA which showed large blood and [**12-3**] RBCs. He had a CT of his
abdomen and pelvis. In addition, for unclear reasons, the
patient had a [**Name (NI) 16992**] in the ED which was mildly elevated at 558
and thus underwent a CTA to rule out PE. His CTA was negative
for PE but coincidentally showed the following: 6.0 x 3.4 x 4.0
cm intracardiac enhancing mass within the right ventricular
outflow tract. This finding is new since the prior CT torso of
[**2185-3-16**]. Cardiology and CT surgery were consulted in the ED. Of
note, the patient has a history of a sinus of Valsalva aneurysm
first noted on an echo in [**2182**].

MEDICAL HISTORY: h/o prostate cancer s/p XRT
Epidermal inclusion cysts
Right inguinal hernia s/p repair in [**2183**]
Emphysema, negative smoking history
Osteoporosis

MEDICATION ON ADMISSION: Flomax 0.4 mg PO QD
Fosamax  70 mg PO QSunday
MVI
Calcium

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tc = 98.1 P=71 BP=115/58 (115-151) RR=18  97% on RA
Gen - NAD, AOX3, pleasant Caucasian male, knees flexed
HEENT - facial erythema over malar eminence and over nasal
bridge, mild telengiectasias, no oral lesions, MMM, JVD with
prominent V wave to 8-10 cm, right carotid bruit ?, none on left
Heart - RRR, Grade III/VI holosystolic harsh murmur over left
sternal border radiating throughout the precordium. No S3, S4.
Non-displaced PMI.
Lungs - CTAB
Abdomen - Voluntary guarding with arm over RUQ, knees flexed, no
rebound/guarding but extremely tender at RUQ and periumbilicus,
no pulsatile masses, no bruits, incompletely evaluated liver
edge given tenderness, no palpable inguinal hernia on left
Back - No CVAT bilaterally
Ext - No C/C/E, +2. d. pedis, no femoral bruits +2 femoral
pulses
Skin - As noted facial erythema with telengiectasias, otherwise
no rashes

FAMILY HISTORY: Father deceased at 71 from MI
Mother died suddenly
Brother deceased at 70 from MI

SOCIAL HISTORY: The patient lives alone in a 1 story apartment. He is
independent with his own ADLs. He drinks on occasion on the
weekends but denies any smoking history. His father and brother
were heavy smokers. 

### Response:
{'Aneurysm of heart (wall),Peripheral vascular complications, not elsewhere classified,Hematoma complicating a procedure,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, Stage II (mild),Aneurysm of artery of lower extremity,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Personal history of malignant neoplasm of prostate,Personal history of irradiation, presenting hazards to health,Osteoporosis, unspecified,Other chronic pulmonary heart diseases,Family history of ischemic heart disease,Calculus of kidney,Other nonspecific abnormal serum enzyme levels'}
