Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath major surgical or invasive procedure: pleurex catheter placement. history of present illness: mr. is a 63yo gentleman with h/o thoracic aortic aneurysm and tobacco abuse admitted with shortness of breath. over the last 3 weeks, mr. has had worsening shortness of breath, particularly at night. he wakes up repeatedly during course of night unable to get his breath. uses a fan to try to relieve his sense of dyspnea and symptoms improve after 15-20 minutes. he describes doe such that he has to stop to rest times when climbing 2 flights of stairs. +chronic cough productive of white sputum. +weight loss of >30 pounds over 3 months. he sleeps with only one pillow. patient also describes chronic tightness around his chest wrapping around his left side to his back at the bottom of his rib cage ever since he had a repair of esophageal rupture about 5 years ago at . over the last 3 weeks, this chronic pain has been more intense. at , he was given nebulizers with some improvement in symptoms. ct chest showed stable aneurysm at 4.5cm but new 2.7x2.6cm non-calcified thrombus. he was also found to have a large, loculated right pleural effusion with r hilar and mediastinal adenopathy compressing his right middle and lower lobe. in the ed, his vs were: 97.5 143/100 86 16 97% 4l. he was started on an esmolol gtt, but continued to have sbp in 150s-160s and pulse in 70s-80s. he also received morphine 4mg iv for pain. ct surgery evaluated the patient and stated there was no indication for surgery. on review of symptoms, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative except as noted above. cardiac review of systems is notable for absence ankle edema, palpitations, syncope or presyncope. past medical history: htn thoracic aortic aneurysm esophageal rupture emesis (boerhaave's syndrome) chronic bronchitis rheumatoid arthritis?? denies h/o cad but has stress test suggestive of prior ischemia (described below) allergies: nkda outpatient cardiologist: in , name unknown pcp: . (?sp) of born, mass social history: social history is significant for the presence of current tobacco use: ppd since the age of 14, continues to smoke. there is a history of alcohol abuse, though he stopped 10 years ago. he also did coke up until 3-4 months ago; he denies ever using iv drugs. family history: there is a family history of premature coronary artery disease or sudden death: his father d. of an mi at the age of 57. his mother is alive at the age of 97. he has a brother who had a stroke at about 60yo. physical exam: vs: t 97.2, bp 152/97, hr 72, rr 24, o2 97% on 4l gen: thin gentleman who is mildly tachypneic and using his accessory muscles to breath. able to speak in full sentences. appears older than stated age. oriented x3. mood, affect appropriate. pleasant. heent: ncat. sclera anicteric. perrl, eomi. +conjunctival pallor. neck: supple with jvp of 8 cm. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no s4, no s3. chest: no chest wall deformities, scoliosis or kyphosis. decreased breath sounds at right base > left base. poor air movement with scattered crackles and wheezes audible. abd: +bs, soft, ntnd, no hsm or tenderness. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp pertinent results: ekgs: no prior for comparison 11:23 nsr with pacs, normal axis, slow r wave progression, non-specific t wave changes (flat in inferior leads and i, avl and twi in v6. 17:03 as above except t waves biphasic in v4 and twi in v5-v6. . telemetry demonstrated: nsr in the 60s. . echo from : mild concentric lvh with reduced lv diastolic compliance. . 2d-echocardiogram (prelim): the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the ascending aorta is mildly dilated. the number of aortic valve leaflets cannot be determined. mild (1+) aortic regurgitation is seen. no mitral regurgitation is seen. there is no pericardial effusion. impression: suboptimal image quality. left ventricular hypertrophy with preserved biventricular systolic function. dilated ascending aorta with mild (1+) aortic regurgitation. if number of aortic cusps needs to be determined, would recommend full study by son. . adenosine stress with nuclear imaging : poor exercise tolerance with normal hr and no chest pain. nonspecific stt changes, no arrhythmias. nuclear imaging suggestive of prior infarct with mild fixed defects in the inferior and mid basal regions. estimated ef 44%. laboratory data: na/k 141/3.8 cl/hco3 106/26 bun/cr 19/0.9 gluc 137 . wbc 13.8 hct 44 plt 326 . inr 1.1 . ck 68 trop 0.01 . ua negative . ct chest : thoracic aortic aneurysm, maximal diameter 4.5cm. no dissection. no mediastinal or hilar adenopathy. multiple nodular appearing areas in both lungs (11mm in left upper lung, etc). . ct chest w/ contrast : unchanged dilatation as compared with prior (max 4.5cm). now has large noncalcified irregular thrombus in distal aspect of the proximal portion of the descending aorta (2.7 x 2.6 cm). left ventricle is hypertrophied; recommend echo to r/o thrombus. complex right pleural effusion with multiple loculations as well as nodules and septations within the effusion. +adenopathy in right hilum and mediastinum with compression of the middle lobe and rll bronchus and significant atelectasis of the middle lobe. highly suspicious for malignancy. --------- ct abd/pelvis: impression: 1. there is no definite evidence of metastatic disease beneath the hemidiaphragms. however, the left adrenal gland is bulky, raising concern for neoplastic involvement. there is a sizable right retrocrural node as well. 2. abnormal soft tissue along the base of the right chest along the superior aspect of the right hemidiaphragm, concerning for neoplasm. there is also a multiloculated right pleural effusion and abnormal densities within the right middle and right lower lobes of the lungs, which are not fully characterized on this study. 3. two rounded hypodensities within the liver, which are not fully characterized. these could represent cysts. 4. changes related to prior esophageal perforation. -------- cxr s/p pleurex catheter placement: impression: 1. interval decrease in volume of right-sided pleural effusion status post drainage of 1.5 liters of fluid. no evidence for pneumothorax. 2. continued right middle and lower lobe atelectasis. -------- cytology: diagnosis: pleural fluid: positive for malignant cells, consistent with malignant epithelioid neoplasm. (see note.) note: the differential diagnosis includes adenocarcinoma and mesothelioma. the corresponding slide from the hematology lab (933a) was reviewed and shows similar findings. immunostains of a cell block preparation are pending and will be reported in an addendum. immunohistochemical studies pleural fluid, cell block (c08-): malignant epithelioid neoplasm, consistent with adenocarcinoma. (see note.) note: immunohistochemical studies show strong positive staining of the tumor cells with keratin ae1-3/cam5.2, ck7, -31 and ttf-1. some tumor cells show faint staining with ck20 and calretinin. there is focal staining of the tumor with leu-m1 and b72.3. the tumor cells do not demonstrate nuclear reactivity with wt-1. the findings favor metastatic adenocarcinoma from the lung. clinical correlation is needed. ----------------- brief hospital course: # pleural effusion: patient describes chronic dyspnea that has been getting worse over the last several weeks. he has significant weight loss, +tobacco abuse, and ct chest with mediastinal adenopathy impinging on his rml and rll bronchi. patient continued to have episodes of tachypnea and subjective shortness of breath during hospital stay, with no hypoxemia, not requiring oxygen, and relieved by nebulizer treatment. ct and cxr revealed loculated right pleural effusion which was drained. cytology was positive for malignant cells, immunostains most consistent with adenocarcinoma of lung origin. a staging abdominal and pelvic ct did not show any clear evidence of malignant spread beneath the diaphragm, although the left adrenal gland was enlarged. in either case, he diagnosed with stage iv adenocarcinoma of likely lung origin. a pleurex catheter was placed for drainage of pleural fluid. dx: adenocarcinoma of the lung, stage iv plan: -to f/u as outpatient with dr. for consideration of palliative chemotherapy. -pleurex catheter to be drained every 2-3 days as tolerated. . # thoracic artery aneurysm: stable on imaging from osh except for new thrombus. he has been hemodynamically stable and has not c/o chest pain. therapeutic anticoagulation was decided against considering multiple procedures while inpatient and risk for bleed and hemothorax. hematology was consulted regarding the need for long term anticoagulation and recommended agatinst anticoagulating aortic thrombus as thought to local plaque build-up. dx: thoracic aortic aneurysm with aortic thrombus plan: -medical management of blood pressure with goal sbp 100-120's -no anticoagulation at this time. . # htn: in the icu, labetalol iv gtt for bp control. on the floor, sbp ranging between 130s-160s, goal was below 130 considering thoracic aortic aneurysm. treated with atenolol, lisinopril and amlodipine. dx: hypertension plan: medical management with goal pressures <130 . # copd: patient with frequent episodes of wheezing in-house requiring almost daily nebulizer therapy. started on fluticasone/salmeterol with prn albuterol. dx: copd plan: - advair, albuterol, atrovent - pleurex catheter mgmt. . # cad: contined aspirin, beta blocker, acr i and statin . # concern for lv thrombus: there was initial concern at osh for lv thrombus, but echo showed no evidence of lv thrombus. . # communication: with girlfriend . remainder of hospital stay was uneventful. medications on admission: enalapril 20mg po bid hctz 25mg daily atenolol 50mg po daily sulfazalazine 500mg po bid hydroxychloroquine 200mg prozac 20mg daily asa 81mg daily protonix 40mg daily albuterol inh 1-2 puffs q6 prn discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 2. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). 6. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 7. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 8. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 9. fluoxetine 10 mg capsule sig: one (1) capsule po daily (daily). 10. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4h (every 4 hours) as needed for wheezing. 11. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 12. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 13. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). discharge disposition: extended care facility: the pavillion discharge diagnosis: adenocarcinoma of the lung malignant pleural effusion hypertensive urgency copd hypertension thoracic aortic aneurysm aortic thrombus discharge condition: stable discharge instructions: you were admitted to the hospital for evaluation of difficulty breathing. it was found that your shortness of breath was due to a large accumulation of fluid in your right lung. as you know, this fluid is due to a lung cancer. you had a catheter placed to allow you to drain off this fluid when needed. . please stop smoking. information was given to you on admission regarding smoking cessation. . followup instructions: please follow-up with your primary care physician, , , . please follow-up with dr. (, we have contact their office and you will be contact with a new patient appointment. md, procedure: insertion of intercostal catheter for drainage thoracentesis diagnoses: coronary atherosclerosis of native coronary artery tobacco use disorder unspecified essential hypertension other pulmonary insufficiency, not elsewhere classified thoracic aneurysm without mention of rupture chronic airway obstruction, not elsewhere classified secondary malignant neoplasm of pleura malignant neoplasm of other parts of bronchus or lung embolism and thrombosis of thoracic aorta 

Answer: The patient is high likely exposed to