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: penicillins attending: chief complaint: svc syndrome major surgical or invasive procedure: possible tpa clot lysis and svc venogram and angioplasty??? history of present illness: 61 year old man with metastatic esophageal cancer to liver and lung presents with 2-3 days of vague facial swelling. yesterday morning, patient began to complian of mild positional dyspnea with standing. yesterday afternoon, patient developed acute facial swelling and plethora and bilateral ue edema. he had stopped his lovenox 5 days prior after completed a shorted course as determined given the emphasis on quality of life and goals of care. lovenox was for a sponatenous r upper extremity dvt on . . he began on epirubicin, cisplatin, and xeloda on . however, he developed severe dehydration, mouth sores, and overall failure to thrive on this and was admitted to the hospital on , eight days after his treatment. he ended up having a prolonged admission for several weeks during which time he developed febrile neutropenia, numerous infections, and pneumococcal bacteremia as well as acute renal failure and thrombocytopenia. he also was found to have right and was started on lovenox for that. patient has tpn/lab dual port, esophageal stent placed, was admitted with facial swelling and found to have svc syndrome likely due to a clot in the svc around his port. . in the ed, vss, ct chest with no evidence of pe but evidence of acute on chronic svc syndrome. patient was started on heparin drip. . ros: otherwise negative past medical history: past oncologic history: ====================== he initially presented in due to dysphagia and weight loss. at that time, he had a barium swallow, which showed a pinpoint narrowing of his distal esophagus. he had endoscopy and underwent dilatation of this stricture. he did not have much improvement with the dilatation and in of this year underwent a second dilatation once again with no improvement. he had motility tests, which were most consistent with achalasia. in , he underwent a botox injection to the narrowing in order to help to release it. he had a ct scan after this which showed a 1.5 cm gastrohepatic lymph node. on he underwent an upper endoscopy on which they saw distal esophageal narrowing. they also performed multiple biopsies of the area of narrowing. of note, they saw some ulceration in the ge junction and a thick abnormal fold concerning for esophageal or gastric cardia cancer. the biopsy showed moderate to poorly differentiated adenocarcinoma. after this he underwent endoscopic ultrasound, however, they were unable to pass the ultrasound probe beyond the stricture. he has had a port, g-tube, and esophageal stent placed. he started treatment with 5-fu and cisplatin on with concurrent radiation therapy. radiation was completed on . he was admitted from to the with febrile neutropenia and dehydration. he underwent an esophagectomy on . pathology from this showed a metastatic adenocarcinoma with 4/6 perigastric lymph nodes positive, and a separate foci of tumor in the adjacent adipose tissue. he completed treatment in . he had liver lesions noted on a ct scan . he had these biopsied on and the pathology came back as consistent with metastasis from esophageal cancer. . past medical history: ==================== - esophageal cancer- moderate to poorly differentiated adenocarcinoma; rec'd 5-fu/cisplatin with concurrent xrt in , now s/p minimally invasive esophagectomy . - h/o atrial fibrillation - h/o s. viridans bacteremia - sinusitis, status post surgery - hypertension - vocal cord paralysis social history: he originally moved from 17 years ago. married, 2 children. teaches french and spanish. he used to smoke a pack a day, but quit 15 years ago. he used to drink a couple of glasses of wine with dinner each night, but not since diagnosis. family history: he has a father with pancreatic cancer who died at the age of 70. physical exam: vitals - 96.3, 126/70, 111, 22, 93% 2l general: nad, very pelasant gentleman, hoarse skin: warm and well perfused, ue plethora, superficial veins over abdomen serving as collaterals heent: at/nc, eomi, perrla, facial plethora, endemotous cheeks, anicteric sclera, patent nares, mmm, good dentition, no lad cardiac: rrr, s1/s2, no mrg lung: ctab abdomen: nondistended, +bs, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly m/s: moving all extremities well, bilateral upper ext plethora and hand swelling, 1+ pitting, pulses: 2+ dp pulses bilaterally neuro: cn ii-xii intact, strenght in upper and lower extremities, dtrs pertinent results: 03:30am pt-12.9 ptt-22.3 inr(pt)-1.1 03:30am wbc-9.4 rbc-4.40* hgb-13.7* hct-41.1 mcv-93 mch-31.1 mchc-33.3 rdw-16.1* 03:30am ck-mb-notdone ctropnt-<0.01 probnp-110 03:30am alt(sgpt)-70* ast(sgot)-32 ck(cpk)-20* alk phos-224* tot bili-0.6 03:30am glucose-114* urea n-29* creat-0.7 sodium-139 potassium-4.2 chloride-102 total co2-26 anion gap-15 cta chest : 1. narrowed lumen of the distal svc is chronic. however, thrombosis of the svc along the mediport catheter is new. together with diffuse stranding of the upper chest wall and opacification of multiple collateral vessels, findings are consistent with svc syndrome. 2. status post esophagectomy with gastric pull-up. the gastric pull-up is filled with fluid. tree-in- opacities in the right lung are improved. mild consolidation in the left lower lung was previously present and may represent aspiration with atelectasis. 3. left pleural effusion is improved. 4. liver metastases. 5. likely evolving splenic infarct. 6. left diaphragmatic hernia containing a loop of transverse colon. venogram: brief hospital course: patient is a 61 year old male with metstatic esophageal cancer presenting with svc syndrome secondary port clot on hep gtt. . # svc syndrome - secondary to visible port clot on dual lumen port placed in 7/. patient had completed course of lovenox for r ue dvt spontanous 5 days prior. patient will now need lifelong anticoagulation. no indication for steroids or diruetics. endovascular stent placement not needed and no evidence of airway obstruction. pt was started on heparin gtt with improvement of sxs. subsequent venogram continued to show extensive clot burden. pt had a tpa infusion for 1 day without complete resolution of the clot; pt was monitored in the icu during this time and there were no complications. discussion among oncology, surgery, and ir resulted in the decision not to remove the port. pt was transitioned from heparin gtt to lovenox on the floor . # esophageal cancer - known liver and lung mets. causing external compression of svc. patient was not able to tolerate chemo. given progression of disease, goal is quality of life. family meeting was done as outpatient and no further chemo to be administered. . # nutrition - patient was started on tpn one month in setting of progression of esophageal ca and colitis. patient is eating 3 meals per day with 1-2 nutritional supplements. megace had been stopped on previous admission but resuming now. - regular diet with ensure supplementation - nutrition c/s for tpn taper, not done now, since no tpn - patient successfully tolerated po, eating croissants, ensure and a regular diet prior to d/c . # full code medications on admission: lovenox 80mg sc bid lorazepam 0.5-1mg q4-6h prn megestrol 400 mg po daily metoclopramide 5mg tid metoprolol 100mg oxycodone 5-10mg q4-6h prn prochlorperazine 10mg q6-8h prn omeprazole 20mg po daily zolpidem 10mg hs prn zofran 8mg po q8h prn discharge medications: 1. lovenox 80 mg/0.8 ml syringe sig: one (1) syringe subcutaneous every twelve (12) hours. disp:*100 syringes* refills:*2* 2. lorazepam 0.5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for nausea. 3. megestrol 400 mg/10 ml (40 mg/ml) suspension sig: one (1) po daily (daily). disp:*qs qs* refills:*2* 4. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 6. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. 7. zolpidem 5 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for insomnia. 8. heparin flush (10 units/ml) 5 ml iv prn line flush indwelling port (e.g. portacath), heparin dependent: flush with 10 ml normal saline followed by heparin as above daily and prn per lumen. 9. heparin flush (100 units/ml) 5 ml iv prn de-accessing port indwelling port (e.g. portacath), heparin dependent: when de-accessing port, instill heparin as above per lumen. 10. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 11. zofran odt 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. 12. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*70 tablet(s)* refills:*0* 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. tablet(s) 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. oxycodone 5 mg tablet sig: one (1) tablet po every twelve (12) hours as needed for pain. disp:*20 tablet(s)* refills:*0* 16. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every six (6) hours as needed for nausea. disp:*40 tablet, rapid dissolve(s)* refills:*2* discharge disposition: home with service facility: vna of -east & visiting nurse hospice discharge diagnosis: primary: svc symdrome secondary to clot around mediport s/p lysis of clot s/p venogram and ballon angioplasty and rotorooter metastatic esophageal cancer s/p upper dvt discharge condition: stable, afebrile, tolerating diet discharge instructions: you were admitted for facial swelling which was found to be caused by a clot around your port site causing "superior vena cava" syndrome. you required clot lysis with a heparin drip. you are to continue lovenox for lifelong anticoagulation. you underwent a venogram and a vessel angioplasty balloon dialation procedure. please take all medications as prescribed. go to all scheduled follow up appointments. . contact your physician if you develop repeated swelling of your face or upper extremity edema as this may reflect another clot around your port. development of unilateral leg swelling or sudden shortness of breath and chest pain may also reflect a blood clot. followup instructions: provider: phone: date/time: 10:30 provider: , md phone: date/time: 1:40 provider: , md phone: date/time: 10:00 procedure: angioplasty of other non-coronary vessel(s) injection or infusion of thrombolytic agent injection or infusion of thrombolytic agent angiocardiography of venae cavae angiocardiography of venae cavae angiocardiography of venae cavae procedure on two vessels diagnoses: malignant neoplasm of liver, secondary unspecified essential hypertension atrial fibrillation compression of vein other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other complications due to other vascular device, implant, and graft secondary malignant neoplasm of lung personal history of malignant neoplasm of esophagus 

Answer: The patient is high likely exposed to