CHIEF COMPLAINT: Arm Swelling

PRESENT ILLNESS: 41 yo M with lung cancer hx SVC syndrome, mult subclavian stents
s/p stents presents with R arm swelling.  He has been
anticoagulated on lovenox.  The patient first noted the swelling
with exercise 3 days prior to admission.  He presented to the
emergency room at [**Hospital1 18**] and was eval by IR.  The swelling
resolved spontaneously and he was sent home with plans for a
follow up venogram the following wednesday [**2190-8-5**].  The patient
began to have HA and back pain over the weekend consistent with
muscle tightness.  The headache is in the occipital region and
feels like muscle tightness extending into the back of his neck.
 This was extemely worrisome to him because this is what he felt
when he originally was dx with cancer.  He also noted that his R
arm was becoming more swollen with increased vascular markings.
.
Of note, the patient stopped his irressa 2 weeks prior to
admission.  This was the patient's decision after discussion
with Dr. [**Last Name (STitle) 17535**].
.
Other than the above the patient has negative review of
symptoms.  Denies fevers, chills, chest pain, shortness of
breath, changes in vision/hearing, URI symptoms, cough,
epistaxis, neck pain, difficulty swallowing, abd pain, nausea,
vomitting, diarrhea, constipation, BRBPR, hematuria, dysuria,
numbness, tingling, focal weakness, malaise, or fatigue.

MEDICAL HISTORY: Onc Hx: Patient presented with increasing respiratory infections
and with large mediastinal mass leading to SVC syndrome.  Found
to have bulky adenocarcinoma.  Tx with XRT, carboplatin, Taxol.
Patient Has had mult episodes of SVC syndrome requiring lysis
and stenting on 3 occasions from [**2186**]-[**2187**].  He had been
anticoagulated on lovenox.  He also began Irressa in [**7-/2186**] and
has been successfully treated for 4 years without evidence of
increase in disease.  Stopped iressa 2 weeks prior to admission.
.
PMH:
- congenital absence of kidney

MEDICATION ON ADMISSION: lovenox

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 97.4  BP 100/68  P 91  R 20  O2  96% on RA  Wt 133.8
Gen - A+Ox3 NAD, extremelyt thin
HEENT - EOMI, OP clear, PERRL, MMM
LAD - no axillary, cervical, occipital, subclavian
Neck - Supple, good ROM
Cor - RRR no m/r/g  S3
Chest - CTA B
Back - no spinal tenderness, no CVA tenderness, paraspinal
muscles in upper torso are tight and tender
Ext - no c/c/e, increased vascularity in R arm/shoulder/chest
Skin - post rediation angioectasia on mid/right chest
Neuro - CN II-XII intact, normal strength and sensation x 4
extremities, normal gait

FAMILY HISTORY: mGF - lung ca

SOCIAL HISTORY: lives in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] with wife and 3 sons
works in construction/landscaping
no tob, occ etoh, no drugs
former tob > 40 pack years quit [**2185**]
Other complications due to other vascular device, implant, and graft,Malignant neoplasm of other parts of bronchus or lung
Comp-oth vasc dev/graft,Mal neo bronch/lung NEC
Admission Date:  [**2190-8-3**]              Discharge Date:   [**2190-8-5**]

Date of Birth:  [**2148-10-8**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
Arm Swelling

Major Surgical or Invasive Procedure:
Angioplasty of R brachicephalic and R subclavian vein and
replacement of stent with tPA


History of Present Illness:
41 yo M with lung cancer hx SVC syndrome, mult subclavian stents
s/p stents presents with R arm swelling.  He has been
anticoagulated on lovenox.  The patient first noted the swelling
with exercise 3 days prior to admission.  He presented to the
emergency room at [**Hospital1 18**] and was eval by IR.  The swelling
resolved spontaneously and he was sent home with plans for a
follow up venogram the following wednesday [**2190-8-5**].  The patient
began to have HA and back pain over the weekend consistent with
muscle tightness.  The headache is in the occipital region and
feels like muscle tightness extending into the back of his neck.
 This was extemely worrisome to him because this is what he felt
when he originally was dx with cancer.  He also noted that his R
arm was becoming more swollen with increased vascular markings.
.
Of note, the patient stopped his irressa 2 weeks prior to
admission.  This was the patient's decision after discussion
with Dr. [**Last Name (STitle) 17535**].
.
Other than the above the patient has negative review of
symptoms.  Denies fevers, chills, chest pain, shortness of
breath, changes in vision/hearing, URI symptoms, cough,
epistaxis, neck pain, difficulty swallowing, abd pain, nausea,
vomitting, diarrhea, constipation, BRBPR, hematuria, dysuria,
numbness, tingling, focal weakness, malaise, or fatigue.


Past Medical History:
Onc Hx: Patient presented with increasing respiratory infections
and with large mediastinal mass leading to SVC syndrome.  Found
to have bulky adenocarcinoma.  Tx with XRT, carboplatin, Taxol.
Patient Has had mult episodes of SVC syndrome requiring lysis
and stenting on 3 occasions from [**2186**]-[**2187**].  He had been
anticoagulated on lovenox.  He also began Irressa in [**7-/2186**] and
has been successfully treated for 4 years without evidence of
increase in disease.  Stopped iressa 2 weeks prior to admission.
.
PMH:
- congenital absence of kidney

Social History:
lives in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] with wife and 3 sons
works in construction/landscaping
no tob, occ etoh, no drugs
former tob > 40 pack years quit [**2185**]

Family History:
mGF - lung ca

Physical Exam:
T 97.4  BP 100/68  P 91  R 20  O2  96% on RA  Wt 133.8
Gen - A+Ox3 NAD, extremelyt thin
HEENT - EOMI, OP clear, PERRL, MMM
LAD - no axillary, cervical, occipital, subclavian
Neck - Supple, good ROM
Cor - RRR no m/r/g  S3
Chest - CTA B
Back - no spinal tenderness, no CVA tenderness, paraspinal
muscles in upper torso are tight and tender
Ext - no c/c/e, increased vascularity in R arm/shoulder/chest
Skin - post rediation angioectasia on mid/right chest
Neuro - CN II-XII intact, normal strength and sensation x 4
extremities, normal gait


Pertinent Results:
[**2190-8-3**] 04:05PM   GLUCOSE-92 UREA N-14 CREAT-1.0 SODIUM-140
POTASSIUM-4.1 CHLORIDE-104 TOTAL CO2-25 ANION GAP-15
[**2190-8-3**] 04:05PM   ALT(SGPT)-19 AST(SGOT)-25 ALK PHOS-67 TOT
BILI-0.6
[**2190-8-3**] 04:05PM   ALBUMIN-4.4 CALCIUM-9.1
[**2190-8-3**] 04:05PM   WBC-5.1 RBC-4.48* HGB-14.1 HCT-39.6* MCV-88
MCH-31.6 MCHC-35.8* RDW-12.8
[**2190-8-3**] 04:05PM   NEUTS-75.0* LYMPHS-15.8* MONOS-3.3 EOS-5.3*
BASOS-0.5
[**2190-8-3**] 04:05PM   PLT COUNT-156
[**2190-8-3**] 04:05PM   PT-12.4 PTT-29.7 INR(PT)-1.0
.
Rad: [**8-1**] US RUE - No flow detectable within the proximal right
brachial vein, at the area of the indwelling stent, suggesting
occlusive thrombus. No other areas of DVT identified.

Brief Hospital Course:
A/P: 41 yo M with lung cancer and h/o SVC syndrome, s/p multiple
subclavian stents who now presents with R arm swelling.
.
1) Subclavian Thrombus - Mr. [**Known lastname **] presented with symptoms of R
arm swelling, increased vascular markings on his R arm, and
neck/upper back pain. These symptoms were similiar to symptoms
he had at the time of his cancer diagnosis when he had SVC
syndrome. On admission, he had a CT scan of his chest and upper
abdomen which showed stable changes in the right paratracheal
and right subcarinal regions, a slightly increased right pleural
effusion with minimal pericardial effusion, and a filling defect
in the SVC with a patent left subclavian stent. CT scan of the
head showed no evidence of intracranial metastatic disease. Pt
went to IR to have angioplasty of the R brachiocephalic and
subclavian stents and restenting performed. The angioplasty was
performed without any complications, tPA was infused, and the
patient came to the [**Hospital Unit Name 153**] post-procedure for monitoring. He was
placed on a heparin gtt overnight for bridging back to Lovenox.
On discharge, his Lovenox dose was increased to 60mg SC BID.
.
2) Headache/Back Pain - Resolved with stenting of his R
subclavian vein.
.
3) Onc - Patient has stopped Irressa recently. Advised to
follow-up with his oncologist about restarting Irressa.
.
4) FEN - House diet.
.
5) PPx - IV heparin.
.
6) FULL CODE
.
7) Discharged to home with Lovenox.

Medications on Admission:
lovenox

Discharge Medications:
1. Lovenox 60 mg/0.6mL Syringe Sig: One (1) syringe Subcutaneous
twice a day: Continue for at least 2 weeks or until further
instruction by Dr. [**First Name (STitle) **].
Disp:*60 syringes* Refills:*1*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:
Subclavian vein thrombus

Secondary diagnosis:
h/o lung cancer


Discharge Condition:
Stable, with no symptoms of numbness or tingling in his R hand
or swelling in his R arm.

Discharge Instructions:
Your dose of Lovenox has been increased.

Please call your PCP if you develop any of the following
symptoms: swelling in your right arm, numbness or tingling in
your right hand, back or neck pain, headaches, chest pain,
shortness of breath, or any other complaints.

Followup Instructions:
Please call Dr.[**Name (NI) 40092**] office and make an appointment to see her
in [**1-31**] weeks.

Please follow-up with Dr. [**Last Name (STitle) 17535**] in [**1-31**] weeks.

Please follow-up with your PCP [**Last Name (NamePattern4) **] [**1-31**] weeks.



                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Other complications due to other vascular device, implant, and graft,Malignant neoplasm of other parts of bronchus or lung'}


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: Arm Swelling

PRESENT ILLNESS: 41 yo M with lung cancer hx SVC syndrome, mult subclavian stents
s/p stents presents with R arm swelling.  He has been
anticoagulated on lovenox.  The patient first noted the swelling
with exercise 3 days prior to admission.  He presented to the
emergency room at [**Hospital1 18**] and was eval by IR.  The swelling
resolved spontaneously and he was sent home with plans for a
follow up venogram the following wednesday [**2190-8-5**].  The patient
began to have HA and back pain over the weekend consistent with
muscle tightness.  The headache is in the occipital region and
feels like muscle tightness extending into the back of his neck.
 This was extemely worrisome to him because this is what he felt
when he originally was dx with cancer.  He also noted that his R
arm was becoming more swollen with increased vascular markings.
.
Of note, the patient stopped his irressa 2 weeks prior to
admission.  This was the patient's decision after discussion
with Dr. [**Last Name (STitle) 17535**].
.
Other than the above the patient has negative review of
symptoms.  Denies fevers, chills, chest pain, shortness of
breath, changes in vision/hearing, URI symptoms, cough,
epistaxis, neck pain, difficulty swallowing, abd pain, nausea,
vomitting, diarrhea, constipation, BRBPR, hematuria, dysuria,
numbness, tingling, focal weakness, malaise, or fatigue.

MEDICAL HISTORY: Onc Hx: Patient presented with increasing respiratory infections
and with large mediastinal mass leading to SVC syndrome.  Found
to have bulky adenocarcinoma.  Tx with XRT, carboplatin, Taxol.
Patient Has had mult episodes of SVC syndrome requiring lysis
and stenting on 3 occasions from [**2186**]-[**2187**].  He had been
anticoagulated on lovenox.  He also began Irressa in [**7-/2186**] and
has been successfully treated for 4 years without evidence of
increase in disease.  Stopped iressa 2 weeks prior to admission.
.
PMH:
- congenital absence of kidney

MEDICATION ON ADMISSION: lovenox

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 97.4  BP 100/68  P 91  R 20  O2  96% on RA  Wt 133.8
Gen - A+Ox3 NAD, extremelyt thin
HEENT - EOMI, OP clear, PERRL, MMM
LAD - no axillary, cervical, occipital, subclavian
Neck - Supple, good ROM
Cor - RRR no m/r/g  S3
Chest - CTA B
Back - no spinal tenderness, no CVA tenderness, paraspinal
muscles in upper torso are tight and tender
Ext - no c/c/e, increased vascularity in R arm/shoulder/chest
Skin - post rediation angioectasia on mid/right chest
Neuro - CN II-XII intact, normal strength and sensation x 4
extremities, normal gait

FAMILY HISTORY: mGF - lung ca

SOCIAL HISTORY: lives in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] with wife and 3 sons
works in construction/landscaping
no tob, occ etoh, no drugs
former tob > 40 pack years quit [**2185**] 

### Response:
{'Other complications due to other vascular device, implant, and graft,Malignant neoplasm of other parts of bronchus or lung'}
