CHIEF COMPLAINT: Cough and Dyspnea on Exertion

PRESENT ILLNESS: 24M w/o significant PMHx w/ 4-5d of productive cough, DOE and L
axillary mass. Also reported tender left axillary mass and
associated discomfort which he noticed 2 days PTA. For the past
week, he has had prod cough w/ thick yellow sputum and sore
throat. He denies F/C. After a few days of coughing, developed
pain with coughing and deep inspiration. DOE when walking up 3
flights of stairs. At baseline, no physical limitations. Has had
intermittent, mild L arm pain for the past couple of days.

MEDICAL HISTORY: MVA ([**10-21**]) with Lumbar Myofascial Inflammation

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: R99 HR110 BP125/47 RR30 OS96%RA
GEN: Mild resp distress.
HEENT: MMM. Clear OP.
Neck: Multiple enlarged anterior cervical lymph nodes.
CV: Tachycardic. NL 21/S2. II/VI SEM AT LSB.
RESP: No breath sounds on left. Right basilar crackles.
ABD: S/NT/ND. Pos BS.
Groin: No LAD or bruits.
EXT: No CCE. DP 2+ B/L.
Neuro: A&Ox3. CNII-XII grossly intact. Strength V/V and
sensation to LT intact throughout.

FAMILY HISTORY: Cousin had leukemia. Mother and Sister have seizure disorders.
Father had prostate cancer and MI (age 57). Grandmother had
breast cancer.

SOCIAL HISTORY: [**Location 7979**]. Lives with mom and sister. [**Name (NI) 1403**] at Stop and Shop
warehouse as a selector. Previous marijuana use. Drinks 3-4
beers/week. No cigarettes. No other illegal drug use.
Acute lymphoid leukemia, without mention of having achieved remission,Hemopericardium,Elevated blood pressure reading without diagnosis of hypertension
Ac lym leuk wo achv rmsn,Hemopericardium,Elev bl pres w/o hypertn
Admission Date:  [**2137-12-13**]              Discharge Date:   [**2137-12-27**]

Date of Birth:  [**2113-9-9**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 106**]
Chief Complaint:
Cough and Dyspnea on Exertion

Major Surgical or Invasive Procedure:
Cardiac Catheterization, Pericardiocentesis, Pleurocentesis and
Hickman Line Placement.


History of Present Illness:
24M w/o significant PMHx w/ 4-5d of productive cough, DOE and L
axillary mass. Also reported tender left axillary mass and
associated discomfort which he noticed 2 days PTA. For the past
week, he has had prod cough w/ thick yellow sputum and sore
throat. He denies F/C. After a few days of coughing, developed
pain with coughing and deep inspiration. DOE when walking up 3
flights of stairs. At baseline, no physical limitations. Has had
intermittent, mild L arm pain for the past couple of days.

ROS: Denies fevers, chills, fatigue, weight loss, decreased
appetite. He denies nausea, vomiting, abdominal pain, diarrhea,
constipation, dysuria, urinary symptoms.

[**Hospital1 18**] ED: Pericardial tamponade by ECHO (RA diastolic collapse
and RV compression) with pulsus paradoxus of 18-20 and
tachycardia. Had successful pericardiocentesis (removal of 600cc
of straw colored fluid) and drain placement.

Past Medical History:
MVA ([**10-21**]) with Lumbar Myofascial Inflammation

Social History:
[**Location 7979**]. Lives with mom and sister. [**Name (NI) 1403**] at Stop and Shop
warehouse as a selector. Previous marijuana use. Drinks 3-4
beers/week. No cigarettes. No other illegal drug use.

Family History:
Cousin had leukemia. Mother and Sister have seizure disorders.
Father had prostate cancer and MI (age 57). Grandmother had
breast cancer.

Physical Exam:
R99 HR110 BP125/47 RR30 OS96%RA
GEN: Mild resp distress.
HEENT: MMM. Clear OP.
Neck: Multiple enlarged anterior cervical lymph nodes.
CV: Tachycardic. NL 21/S2. II/VI SEM AT LSB.
RESP: No breath sounds on left. Right basilar crackles.
ABD: S/NT/ND. Pos BS.
Groin: No LAD or bruits.
EXT: No CCE. DP 2+ B/L.
Neuro: A&Ox3. CNII-XII grossly intact. Strength V/V and
sensation to LT intact throughout.


Pertinent Results:
Bone Marrow Flow Cytometry ([**2137-12-13**]): PERIPHERAL SMEAR: Smear
quality is acceptable. Red cells show minimal anisocytosis and
rare nucleated red blood cells. WBC count is increased.
Differential shows  10% segmented neutrophils, 1% metamyelocyte,
1% myelocyte, 2% monocytes, 7% lymphocytes, 1% eosinophils, and
78% blasts.  Occasional blasts have cytoplasmic granules.
Platelet count appears normal; occasional large forms are
present. ASPIRATE SMEARS: The aspirate material is adequate for
evaluation.  It consists predominantly of variably-sized blasts
with scant cytoplasm, irregular convoluted nuclei with fine
chromatin and multiple nucleoli.  In the residual hematopoietic
cells,  M:E ratio is 0.7:1.  Myeloid cells appear decreased.
Erythroid maturation is normoblastic. Granulocyte maturation is
normal. Megakaryocytes are decreased in number; many immature
hypolobated forms are present. Differential shows: Blasts 90%,
Promyelocytes <1%, Myelocytes <1%, Metamyelocytes 1%,
Bands/Neutrophils 2%, Plasma cells 1%, Lymphocytes <1%,
Erythroid 6%. ADDENDUM: Immunostains reveal the blasts are
positive for TdT, and negative for CD1a. Scattered cells show
membranous staining for CD3.FLOW RESULTS: Three color gating is
performed (light scatter vs. CD45) to optimize blast yield. Cell
marker analysis demonstrates that the majority of the cells
isolated from this peripheral blood express lymphoid-associated
antigens CD5, 7, 8 (dim) and 71.  They lack CD2, 3, 4, 10
(cALLa), 11c, 13, 14, 15, 19, 20, 33, 34, 41, 56, 64, 117,
HLA-DR, glycophorin A, kappa and lambda. Blast cells comprise
~50% of total analyzed events. INTERPRETATION: Immunophenotypic
findings consistent with involvement by acute lymphoblastic
leukemia, T-cell type.

CXR ([**2137-12-13**]): CHEST, PA & LATERAL: There are no prior films
for comparison. There is a large left pleural effusion. Minimal
aeration is present at the left apex. There is right upper lobe
and right lower lobe atelectasis. The heart appears
mildly enlarged. The right lung is clear. The osseous structures
are unremarkable. IMPRESSION: 1) Large left pleural effusion. 2)
Enlarged cardiac silhouette. This may be due to cardiomegaly vs.
pericardial effusion.

CT CHEST ([**2137-12-13**]): IMPRESSION: 1) Anterior mediastinal mass
extending along the paracardium and to the left lung pleura with
superior mediastinal, supraclavicular, with left axillary
lymphadenopathy and with large pericardial and pleural
effusions. Potential etiologies include lymphom and germcell
tumor. A primary thymic tumor is
possible but considered less likely given the lymphadenopathy
and the
patient's age. 2) Hepatomegaly and a small amount of
pericholecystic fluid. This is a non-specific finding.

ECHO/TTE ([**2137-12-13**]): LVEF>55%. The left atrium is normal in
size. Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal and systolic function is
normal. The right ventricular cavity is small/compressed. Right
ventricular systolic function is normal. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic regurgitation. The mitral valve appears
structurally normal with trivial mitral regurgitation. There is
a large pericardial effusion. There is sustained right atrial
collapse, consistent with low filling pressures or tamponade.
There is right ventricular compression. These findings are
consistent with tamponade. Clinical correlation recommended.

CARD CATH/PERICARDIOCENTESIS ([**2137-12-13**]): FINAL DIAGNOSIS: 1.
Severe pericardial tamponade. 2. Removal of 600 cc of
pericardial fluid. COMMENTS: 1. Resting hemodynamics
deomonstrated elevated right and left sided pressures with
blunted Y descent and elevation of pericardial pressures with
equalization of RA and pericardial pressures (18 mmHg)
consistent with tamponade. Upon removal of pericardial fluid, RA
pressure decreased 8 mmHg, and pericardial pressure decreased to
0 mmHg. The cardiac index improved from 1.9 l/min/m2 to 3.1
l/min/m2 with removal of pericardial fluid. 2.
Pericardiocentesis was performed in one pass with withdrawl of
approximately 600 cc of straw colored fluid.

ECHO/TTE ([**2137-12-16**]): 1. Left ventricular wall thickness, cavity
size, and systolic function are normal (LVEF>55%). Regional left
ventricular wall motion is normal.
2. There is a small pericardial effusion with fibrin deposits on
the surface of the heart. There are no echocardiographic signs
of tamponade. 3. Compared with the findings of the prior report
(tape unavailable for review) of [**2137-12-13**], the pericardial
effusion is almost gone.

CXR ([**2137-12-20**]): PA & LATERAL VIEWS CHEST: The left hilar mass is
unchanged. There is interval slight improvement in the left
pleural effusion and left lower lobe opacity. No evidence of
pneumothorax. IMPRESSION: Interval improvement in left pleural
effusion and left lower lobe opacity.

[**2137-12-13**] 02:50AM   IPT-DONE
[**2137-12-13**] 02:50AM   PT-14.3* PTT-23.9 INR(PT)-1.3
[**2137-12-13**] 02:50AM   PLT SMR-NORMAL PLT COUNT-157
[**2137-12-13**] 02:50AM   HYPOCHROM-1+ ANISOCYT-NORMAL POIKILOCY-NORMAL
MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-1+
[**2137-12-13**] 02:50AM   NEUTS-19* BANDS-0 LYMPHS-7* MONOS-2 EOS-1
BASOS-1 ATYPS-3* METAS-0 MYELOS-0 BLASTS-66* PLASMA-1*
[**2137-12-13**] 02:50AM   WBC-38.4*# RBC-5.22 HGB-15.5 HCT-44.2 MCV-85
MCH-29.6 MCHC-35.0 RDW-13.5
[**2137-12-13**] 02:50AM   ALBUMIN-4.3 CALCIUM-9.8 PHOSPHATE-3.7
MAGNESIUM-2.0 URIC ACID-6.0
[**2137-12-13**] 02:50AM   LIPASE-29
[**2137-12-13**] 02:50AM   ALT(SGPT)-55* AST(SGOT)-35 LD(LDH)-313* ALK
PHOS-105 AMYLASE-42 TOT BILI-0.8
[**2137-12-13**] 02:50AM   GLUCOSE-102 UREA N-11 CREAT-0.9 SODIUM-143
POTASSIUM-4.2 CHLORIDE-106 TOTAL CO2-25 ANION GAP-16
[**2137-12-13**] 09:15AM   FIBRINOGE-266
[**2137-12-13**] 09:15AM   FDP-0-10
[**2137-12-13**] 09:15AM   PT-14.4* PTT-24.4 INR(PT)-1.3
[**2137-12-13**] 09:15AM   PLT SMR-NORMAL PLT COUNT-153
[**2137-12-13**] 09:15AM   HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-NORMAL
MACROCYT-OCCASIONAL MICROCYT-2+ POLYCHROM-1+
[**2137-12-13**] 09:15AM   NEUTS-12* BANDS-0 LYMPHS-8* MONOS-2 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0 BLASTS-78*
[**2137-12-13**] 09:15AM   WBC-38.1* RBC-5.07 HGB-15.1 HCT-42.9 MCV-85
MCH-29.7 MCHC-35.2* RDW-13.8
[**2137-12-13**] 09:15AM   HAPTOGLOB-65
[**2137-12-13**] 09:15AM   CALCIUM-9.4 MAGNESIUM-1.9
[**2137-12-13**] 09:15AM   LD(LDH)-244
[**2137-12-13**] 09:15AM   GLUCOSE-107* UREA N-11 CREAT-0.9 SODIUM-142
POTASSIUM-3.8 CHLORIDE-106 TOTAL CO2-25 ANION GAP-15
[**2137-12-13**] 11:48AM BONE MARROW  IPT-DONE
[**2137-12-13**] 02:15PM OTHER BODY FLUID  WBC-[**Numeric Identifier 23697**]* RBC-4950* POLYS-0
LYMPHS-18* MONOS-0 OTHER-82*
[**2137-12-13**] 02:15PM OTHER BODY FLUID  TOT PROT-5.4 GLUCOSE-47
LD(LDH)-349 AMYLASE-23 ALBUMIN-3.5
[**2137-12-13**] 06:16PM   FIBRINOGE-250
[**2137-12-13**] 06:16PM   PT-14.7* PTT-23.6 INR(PT)-1.4
[**2137-12-13**] 06:16PM   PLT COUNT-172
[**2137-12-13**] 06:16PM   WBC-53.1* RBC-4.90 HGB-14.2 HCT-41.8 MCV-85
MCH-28.9 MCHC-33.9 RDW-13.5
[**2137-12-13**] 06:16PM   TOT PROT-6.1* CALCIUM-9.0 PHOSPHATE-2.9
MAGNESIUM-1.8 URIC ACID-5.3
[**2137-12-13**] 06:16PM   GLUCOSE-123* UREA N-10 CREAT-0.9 SODIUM-141
POTASSIUM-3.8 CHLORIDE-107 TOTAL CO2-25 ANION GAP-13
[**2137-12-13**] 10:44PM   FIBRINOGE-291
[**2137-12-13**] 10:44PM   PT-15.0* PTT-24.0 INR(PT)-1.4
[**2137-12-13**] 10:44PM   PLT COUNT-155
[**2137-12-13**] 10:44PM   WBC-22.2*# RBC-5.18 HGB-15.0 HCT-44.5 MCV-86
MCH-29.0 MCHC-33.8 RDW-13.7
[**2137-12-13**] 10:44PM   HIV Ab-NEGATIVE
[**2137-12-13**] 10:44PM   CALCIUM-9.3 PHOSPHATE-3.0 MAGNESIUM-1.8 URIC
ACID-5.4
[**2137-12-13**] 10:44PM   GLUCOSE-180* UREA N-10 CREAT-1.1 SODIUM-139
POTASSIUM-3.8 CHLORIDE-101 TOTAL CO2-29 ANION GAP-13

Brief Hospital Course:
Mr [**Known lastname **] was admitted to [**Hospital1 18**] with shortness of breath and
pleuritic chest pain which were caused by pleural and
pericardial effusions secondary to mediastinal T-Cell Acute
Lymphocytic Leukemia.

1. T-cell ALL: The patient had no significant medical history on
admission. He presented with shortness of breath and pleuritic
chest pain secondary to large pleural and pericardial effusions.
Upon therapeutic drainage, the pericardial effusion was deemed
malignant by cytology (the pleural effusion was not). Admission
labs revealed a WBC of 38 with 60% blasts. Chest CT imaging
revealed a left-sided mediastinal mass adjacent to the
pericardium, as well as supraclavicular and left axillary
lymphadenopathy. A bone marrow biopsy confirmed T-Cell Acute
Lymphocytic Leukemia. The patient underwent the Hyper-CVAD
chemotherapeutic regimen. Soon after Hyper-CVAD initiation, his
cells lines fell. He was continued G-CSF and his ANC recovered
to >700 on discharge. He had reached a nadir of <100. He was
also given one dose of intrathecal MTX and one dose of
intrathecal ARA-C. There was no cytologic evidence of malignancy
in his cerebrospinal fluid. He was maintained on Levofloxacin,
Fluconazole, Acyclovir and Allopurinol for prophylaxis and had
no fevers throughout his course. He was discharged with
oncologic follow-up and a future allogenic bone marrow
transplant was planned.

3. Malignant Pericardial Effusion: Again, the patient had
symptomatic tamponade on admission. He underwent successful
pericardiocentesis and drain placement, which was later removed.
Thereafter, he remained asymptomatic and stable. Follo-up
echocardiograms were essentially unremarkable. A repeat ECHO in
two to three months was recommended.

4. Left Pleural Effusion: Again, he had a large left pleural
effusion on admision, causing partial colapse of the left lung.
This had essentially resolved after thoracentesis. He had no
respiratory distress and was without an oxygen requirement
throughout the remainder of his course.

Medications on Admission:
None

Discharge Medications:
1. Fluconazole 200 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
2. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
3. Acyclovir 400 mg Tablet Sig: One (1) Tablet PO three times a
day.
Disp:*90 Tablet(s)* Refills:*0*
4. Line Check
VNA: Please attend to PICC according to [**Last Name (un) 6438**] protocol.


Discharge Disposition:
Home With Service

Facility:
[**Last Name (un) 6438**]

Discharge Diagnosis:
Primary Diagnosis: T-Cell Acute Lymphoblastic Leukemia.
Secondary Diagnosis: Malignant Peridcardial Effusion,
Non-Malignant Pleural Effusion.


Discharge Condition:
Good/Stable.

Discharge Instructions:
1) Return to the ER, call the on-call Oncologist at [**Hospital1 18**] ([**Hospital1 18**]
Main Number: [**Telephone/Fax (1) 2756**]), or your primary doctor, if you have
any shortness of breath, chest pain, cough, bruising, bleeding,
sore throat or any other concerning symptoms.
2) Please avoid contact with anyone with a cold, diarrhea, or
any other possible infection. Ensure that you wash your hands
regularly and that those whom you live with due the same (after
using the bathroom, cooking, touching their faces, etc.). Please
purchase and over-the-counter hand sanitizer for this purpose.
Please also avoid close contact with small children or people
coming from hospitals or nursing homes.








Followup Instructions:
1) Please follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] for the
following appointment on Monday, [**2137-12-30**] at 12:00PM:
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3238**], MD Where: [**Hospital6 29**]
HEMATOLOGY/ONCOLOGY Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2137-12-30**] 12:00

2) Please return to the [**Hospital1 18**] Bone Marrow Transplant tomorrow
([**2137-12-28**]) and every day thereafter until instructed
to do otherwise. Your blood counts will be checked and you will
be given an injection of Neupogen to boost your white blood cell
count. Please come to the [**Location (un) 436**] of the [**Hospital Ward Name 1826**] Building on
the [**Hospital1 18**] [**Hospital Ward Name 516**] between 10:00 AM and 3:00 PM. You may call
the BMT floor at [**Telephone/Fax (1) 23698**] if you have any questions.
3) Please see your primary doctor in the next one to two weeks:
[**Last Name (LF) **],[**First Name3 (LF) **] L. ([**Telephone/Fax (1) 7976**]).
{'Acute lymphoid leukemia, without mention of having achieved remission,Hemopericardium,Elevated blood pressure reading without diagnosis of 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: Cough and Dyspnea on Exertion

PRESENT ILLNESS: 24M w/o significant PMHx w/ 4-5d of productive cough, DOE and L
axillary mass. Also reported tender left axillary mass and
associated discomfort which he noticed 2 days PTA. For the past
week, he has had prod cough w/ thick yellow sputum and sore
throat. He denies F/C. After a few days of coughing, developed
pain with coughing and deep inspiration. DOE when walking up 3
flights of stairs. At baseline, no physical limitations. Has had
intermittent, mild L arm pain for the past couple of days.

MEDICAL HISTORY: MVA ([**10-21**]) with Lumbar Myofascial Inflammation

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: R99 HR110 BP125/47 RR30 OS96%RA
GEN: Mild resp distress.
HEENT: MMM. Clear OP.
Neck: Multiple enlarged anterior cervical lymph nodes.
CV: Tachycardic. NL 21/S2. II/VI SEM AT LSB.
RESP: No breath sounds on left. Right basilar crackles.
ABD: S/NT/ND. Pos BS.
Groin: No LAD or bruits.
EXT: No CCE. DP 2+ B/L.
Neuro: A&Ox3. CNII-XII grossly intact. Strength V/V and
sensation to LT intact throughout.

FAMILY HISTORY: Cousin had leukemia. Mother and Sister have seizure disorders.
Father had prostate cancer and MI (age 57). Grandmother had
breast cancer.

SOCIAL HISTORY: [**Location 7979**]. Lives with mom and sister. [**Name (NI) 1403**] at Stop and Shop
warehouse as a selector. Previous marijuana use. Drinks 3-4
beers/week. No cigarettes. No other illegal drug use. 

### Response:
{'Acute lymphoid leukemia, without mention of having achieved remission,Hemopericardium,Elevated blood pressure reading without diagnosis of hypertension'}
