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: no known allergies / adverse drug reactions attending: chief complaint: atrial thrombus seen on echocardiogram major surgical or invasive procedure: 1. endobronchial biopsy (ebus) 2. endobronchial resection of neoplasm invading right bronchus intermedius history of present illness: 79f w/recent diagnosis afib presents from cardiology clinic for workup of possible left atrial thrombus visualized on routine office tte. patient was diagnosed with atrial fibrillation 2 mos ago, when she saw her physician for complaining of feeling her heart fluttering and ongoing fatigue for 3 weeks. ekg showed atrial fibrillation, tte at that time showed lvef 45%. cardiomyopathy was attributed to alcohol use because she drinks 2 shots whiskey nightly in her nightly. she stopped drinking entirely about 1.5 months ago. atrial fibrillation has been difficult to control medically: she was started on sotalol 120 , then switched to dronedarone 400 , then back to 160 mg sotalol about 10 days prior to admission. she had episodes of atrial fibrillation near daily which she feels and documents by self-pulse checks. she started pradaxa about 10 days prior to admission when she called her cardiologist to report an episode of atrial fibrillation lasting >48h. about 10 days prior to admission she also noted new bilateral leg edema. no chest pain, pressure, sob; no nausea/vomiting. she does describe early satiety/food intolerance (gags on small amounts of food due to distaste) ongoing for ~2 months. weight loss of 14 lbs ( lbs voluntarily before , 10 lbs involuntarily since then). she noted no improvement in fatigue symptoms, also no improvement in dry cough which predated her fatigue and palpitations by ~1 year and was nonresponsive to antibiotics (azithromycin) as recently as 2 mos ago. on the day of admission her cardiologist performed a repeat tte to evaluate for any interval improvement since etoh cessation. tte showed possible or external mass compressing la. patient has been compliant with pradaxa since prescribed 10 days prior to admission. she had no neurologic symptoms - no change speech, vision, hearing, motor, sensation, concentration or memory. patient was sent to to further evaluate these tte findings. past medical history: atrial fibrillation (diagnosed ) idiopathic cardiomyopathy, lvef 45% (diagnosed ) osteopenia esophageal reflux benign positional vertigo social history: lives alone, son involved in care. -tobacco history: smoked 1 pack/two weeks x8 years, quit -etoh: lifetime drinker (1 /day with 2 shots of whisky) until 3-4 weeks ago she stopped due to concern for etoh cardiomyopathy. -illicit drugs: denies family history: mother with mi at age 85, son with afib, daughter with breast ca physical exam: admission exam vs: 97.9 98/71 hr 129 rr 20 98/ra general: thin elderly female resting in bed in nad. oriented x3. heent: ncat, perrl, eomi, mmm, + gingival ulcer r upper gums and along toothline. op otherwise clear. neck: supple, jvp 5 above sternal angle, no cervical lad cardiac: irregular rate, normal s1/s2, no mrg lungs: no chest wall deformities. resp unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. no abdominial bruits. extremities: symmetric bilateral 2+ nonpitting edema to thighs, pulses easily palpable skin: no stasis dermatitis, ulcers, scars, or xanthomas neuro: aox3, cn intact, strength 5/5 throughout, gait narrow & stable discharge exam vital signs: t(98.0f-97.6f); , hr 52-74, rr 18, 94% ra. general: alert, oriented, sitting up in bed, appears tired. heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rythm, normal s1,s2. no murmurs, rubs, gallops lungs: ctabl, no rhonchi or wheezes abdomen: soft, non-tender, non-distended, bowel sounds present : warm, well perfused, 2+ pulses, no clubbing, cyanosis. no lower extremity edema. neuro: cn iii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation and strength pertinent results: i) admission labs cbc 11:20am blood wbc-9.7 rbc-4.52 hgb-11.8* hct-39.4 mcv-87 mch-26.1* mchc-29.9* rdw-18.2* plt ct-377 06:34am blood wbc-8.3 rbc-4.36 hgb-11.8* hct-38.0 mcv-87 mch-27.0 mchc-31.0 rdw-17.5* plt ct-414 07:05am blood wbc-8.4 rbc-4.14* hgb-11.0* hct-36.1 mcv-87 mch-26.5* mchc-30.4* rdw-17.4* plt ct-414 07:50am blood wbc-7.8 rbc-4.12* hgb-10.9* hct-36.1 mcv-88 mch-26.5* mchc-30.2* rdw-17.9* plt ct-376 03:40pm blood wbc-8.9 rbc-4.46 hgb-12.0 hct-39.0 mcv-87 mch-26.8* mchc-30.7* rdw-17.7* plt ct-451* differential 07:05am blood neuts-73.3* lymphs-20.4 monos-4.7 eos-1.2 baso-0.5 coags: 03:40pm blood pt-14.3* ptt-29.2 inr(pt)-1.3* 07:50am blood pt-14.8* ptt-34.0 inr(pt)-1.4* 07:50am blood plt ct-376 07:05am blood pt-13.5* ptt-29.8 inr(pt)-1.3* chem 07:05am blood glucose-80 urean-6 creat-0.6 na-135 k-4.2 cl-97 hco3-32 angap-10 07:50am blood glucose-78 urean-7 creat-0.6 na-135 k-4.6 cl-97 hco3-32 angap-11 03:40pm blood glucose-102* urean-9 creat-0.7 na-136 k-4.2 cl-96 hco3-29 angap-15 03:40pm blood calcium-9.0 phos-3.2 mg-1.9 07:50am blood calcium-8.7 phos-3.8 mg-2.0 cardiac enzymes: 03:49am blood ck-mb-3 ctropnt-<0.01 07:13pm blood ck-mb-3 ctropnt-<0.01 ii) microbiology bronchial washings bronchus interredius washing. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): ~6ooo/ml commensal respiratory flora. mrsa screen (final ): no mrsa isolated. gram stain (final ): >25 pmns and >10 epithelial cells/100x field. gram stain indicates extensive contamination with upper respiratory secretions. bacterial culture results are invalid. please submit another specimen. respiratory culture (final ): test cancelled, patient credited. iii) imaging cardiac ct impression: 1. a large mass involving the right lower medial lung extending into the paraesophageal, subcarinal and right hilar mediastinal regions with invasion to the pericardium, right atrium, left atrium and compressing the right airways causing complete collapse of the right middle lobe and partial collapse of the right lower lobe. 2. moderate right-sided pleural effusion. 3. enlarged left supraclavicular lymphnode, 6 x 7 mm solid nodule in the right lower lobe and a suspicious lytic area in the left transverse process of the d1 vertebra and posterior end of the left second rib are concerning for the deposits. 4. uncharacteristic 16 x 17 mm focal hypodensity in the right lobe of liver which is only imaged on the unenhanced series. ultrasound of liver is suggested for further evaluation. tissue sample can be easily obtained by transbronchial approach for tissue diagnosis. the study and the report were reviewed by the staff radiologist. iv) studies: ebus some white-colored mucous plugs were aspirated from the now visible rml and rll and sent for culture. rml showed residual 75% obstruction, rll showed residual 50% obstruction, and the superior segment rll was just barely identified. the had a residual 40% airway obstruction by extrinsic compression. a stent was not placed for adequate airway re-canalization. next, the flexible scope was removed, then the endobronchial ultrasound was inserted. a large mediastinal mass was visualized and sampled from both the right and left carinae, a total of 8 samples with at least 15 passes each was performed for cytology and flow cytometry. the ebus was removed, then the flexible scope re-inserted to suction remaining clot. scopes were removed, then the procedure was then completed. the patient awoke without event. v)discharge labs cbc 06:35am blood wbc-8.7 rbc-4.14* hgb-11.2* hct-36.9 mcv-89 mch-27.0 mchc-30.3* rdw-18.9* plt ct-337 08:44am blood wbc-10.7 rbc-4.28 hgb-11.6* hct-37.8 mcv-88 mch-27.0 mchc-30.6* rdw-18.6* plt ct-359 07:00am blood wbc-9.4# rbc-4.02* hgb-10.7* hct-35.4* mcv-88 mch-26.7* mchc-30.3* rdw-18.7* plt ct-336 coags: 06:35am blood pt-13.4* ptt-103.1* inr(pt)-1.2* 06:35am blood plt ct-337 08:44am blood pt-13.3* ptt-127.2* inr(pt)-1.2* chem 06:35am blood glucose-122* urean-7 creat-0.5 na-133 k-4.3 cl-96 hco3-30 angap-11 08:44am blood glucose-133* urean-7 creat-0.5 na-134 k-4.1 cl-98 hco3-28 angap-12 11:35pm blood glucose-133* urean-7 creat-0.4 na-131* k-3.7 cl-99 hco3-25 angap-11 06:35am blood calcium-8.3* phos-1.8* mg-2.0 vii) studies pending: to be followed by oncology team. urine culture (pending): immunophenotyping - mediastinal mass/ebus tbna report not finalized. assigned pathologist ,ha t. please contact the pathology department, pathology # bronchus intermedius tumor. brief hospital course: ms. is a 79 year old female with recently-diagnosed atrial fibrillation admitted with pericardiac mass and found to have a large mediastinal mass concerning for malignancy with compression of the heart, lung, and esophagus. issues addressed during hospitalization: 1. malignant mediastinal neoplasm 2. atrial fibrillation 3. chronic cough 4. chronic systolic heart failure with a left ventricular ejection fraction of 45%. the patient was initially admitted to the cardiology service after her outpatient cardiologist noticed what was believed at the time to be a right atrial thrombus. inpatient cardiology re-review of this tte and tte showed interval enlargement of an extra-pericardial mass rather than an intra-cardiac thrombus, now compressing the left atrium, which was not clearly apparent by cxr. a chest ct was performed which showed that there was a large mediastinal mass which was compressing the right/left atrium, as well as the lower segment of the right lung, and esophagus. her symptoms of difficult to control atrial fibrillation, chronic dry cough, loss of apetite, mild systolic heart failure as well as loss of appetite were all felt likely to be the result of the mass effect exerted by the tumor. the patient's heart rate was initially very difficult to control. she had several episodes of atrial fibrillation with rapid ventricular rate to the 140s-150s which did not result in hemodynamic instability or chest pain. despite large doses of diltiazem (as high as 360mg per day), she remained in atrial fibrillation with frequent episodes of rapid ventricular response. rate and rythm control was eventually achieved with oral diltiazem 60mg q6h and metoprolol 37.5 mg tid. her blood pressure tolerated this medication regimen and she remained in normal sinus rhythm with occasional asymptomatic pvcs prior to discharge. her anticoagulation, pradaxa, transitioned to ufh in order to obtain a surgical biopsy and subsequently transistioned to lmwh (lovenox) in the event that she would require another procedure should the pathologic specimen obtained during biopsy (see below) be insufficient. since the etiology of the patient's problems were secondary to mass effect caused by the mediastinal neoplasm, tissue biopsy was necessary to inform future decisions on definitive oncologic management. interventional pulmonolgy performed endobronchial biopsy and exploration of the lung for tissue sampling and airway management. during the procedure, they found that the tumor was invading the right lung parenchyma. in addition, there was extensive neoplastic growth causing occlusion of the right bronchus intermedius. fna and tissue biopsy was obtained. in addition, electrocautery was used to open the occluded airway. following the procedure, the patient went into respiratory failure secondary to atrial fibrillation with rapid ventricular response, volume overload, and edema secondary to inflamation from the mechanical instrumentation. she was subsequently transferred from the pacu to the micu for nippv and aggressive diuresis. she was promptly stabilized in the micu and transferred back to general medicine after approximately 18 hours in the medical icu. when she returned to the floor from the micu, her heart rate and rythym remained predominantly in normal sinus rhythm with stable hemodynamics on diltiazem 60mg q6h and metoprolol 37.5 tid. she remained euvolemic with clear breath sounds, and no lower extremity edema. the patient was anticoagulated with daily lovenox once a day 1.5mg/kg rather than resuming pradaxa on initiating coumadin given the liklihood of further procedures in the near future. the patient was also evaluated by medical oncology who is awaiting final pathology results before recommending final treatment. they will follow up the biopsy results and discuss with patient at outpatient follow up including options for treatment. medicine and medical oncology felt that the patient would be best served by inpatient rehabilitation in the sub-acute setting while the final pathology was pending. she was subsequently discharged to rehabilitation. code: full fen: cardiac, low salt diet ppx: lovenox transitional issues: 1. tissue histopathology pending. medicial oncology will contact the patient while she is at rehab to coordinate her subsequent treatment for her cancer. medications on admission: dabigatran etexilate (pradaxa) 150 mg (started 10d ago) sotalol 160 mg (increased 10d ago) fluticasone (flovent hfa) 220 mcg (not using) omeprazole 20 mg daily meclizine 12.5 mg daily prn (not taking) fluocinonide 0.05 % topical cream (uses rarely) discharge medications: 1. dilt-xr 240 mg capsule, release degradable sig: one (1) capsule, release degradable po once a day. disp:*30 capsule, release degradable(s)* refills:*2* 2. lovenox 100 mg/ml syringe sig: one hundred (100) mg subcutaneous once a day. disp:*10 syringe* refills:*2* 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for indigestion. 5. fluocinonide 0.05 % cream sig: one (1) application topical as needed as needed for itching. 6. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. the following medications were started on this admission: 1. diltiazem extended release 240mg once a day 2. metoprolol xl 100mg once a day 3. lovenox subcutaneous injection 100mg once a day 4. calcium carbonate 1000mg qid prn indigestion the following medications were discontinued: 1. pradaxa 2. sotalol 3. fluticasone hfa 4. meclizine discharge disposition: extended care facility: commons residence at orchard - (a.k.a. ) discharge diagnosis: 1. mediastinal neoplasm 2. atrial fibrillation with rapid ventricular response 3. compensated systolic congestive heart failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , you were admitted for workup and evaluation of your atrial fibrillation. you were found to have a large tumor extending in your lung and pressing on your heart. this tumor is also compressing your esophagus. this tumor is what has been causing your difficult to control atrial fibrillation, chronic cough, and loss of appetite. it will most likely take another 4 or 5 days for the final pathology from your biopsy to come back. at that point, the medical oncologists from will arrange your follow up and coordinate your future treatment. there is a small chance that you will need a repeat biopsy for a definitive tissue diagnosis, however, this is unlikely. until your biopsy results are availible, we are making the following changes to your medications. please start: 1. diltiazem extended release 240mg once a day 2. metoprolol xl 100mg once a day 3. lovenox subcutaneous injection 100mg once a day 4. calcium carbonate 1000mg qid prn indigestion please stop: 1. pradaxa 2. sotalol 3. fluticasone hfa 4. meclizine please continue: 1. omeprazole 20mg once a day. 2. fluocinonide 0.05 % topical cream prn if you experience any of the danger signs listed below please alert your physician and come back to the emergency department. followup instructions: oncology , *we are working on a follow up appt in the thoracic oncology department. if you have not heard or have questions, please call . procedure: closed [endoscopic] biopsy of bronchus closed endoscopic biopsy of lung endoscopic excision or destruction of lesion or tissue of bronchus diagnoses: esophageal reflux congestive heart failure, unspecified acute posthemorrhagic anemia atrial fibrillation acute on chronic diastolic heart failure personal history of tobacco use atrial flutter enlargement of lymph nodes stricture and stenosis of esophagus alcoholic cardiomyopathy acute respiratory failure following trauma and surgery other diseases of respiratory system, not elsewhere classified malignant carcinoid tumor of the bronchus and lung 

Answer: The patient is high likely exposed to