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: chest pain major surgical or invasive procedure: pericardiocentesis history of present illness: ms. is a 70 year old female with no significant past medical history who presents with increasing le edema x 4 weeks and chest tightness with exertion x 1 day. the patient sings in a choir and intermittently has le edema after long periods of standing however this typically resolves within a day without intervention. approximately four weeks ago after several days of prolonged standing she developed le edema which did not resolve. she tried teds for compression with only minimal improvement. according to her daughter (a physician) she had truncal edema and appeared anasarcic during this time. she has also noted some increase in abdominal girth. she denies shortness of breath or chest pain over this time, but on more direct questioning, may have had some increased fatigue with activity. . yesterday while ambulating she developed some chest tightness/heaviness radiating up her neck. she also had some associated shortness of breath. she also reported dyspnea with walking one flight of stairs. she has no history of angina or known coronary artery disease. these symptoms resolved with rest. at baseline she is a very active woman with no limitations to her activity and reports that she has never had these symptoms previously. at baseline she is able to lie flat but recently has required 2 pillows due to shortness of breath. she describes approximately 10 lb weight gain over the last month. the patient was noted by her daughter to have distended neck veins, and decided to bring the patient into the ed. . she denies any recent fevers, chills, abdominal pain, nausea or vomiting however does regularly take care of young grandchildren who may have been sick. she had an oral herpetic lesion three months ago which has now resolved. she does note some mild lower abdominal fullness and possibly decreased urinary output than previously. she has had no recent foreign travel, cough, or hemoptysis. she is up to date with screening mammogram and pap smear, but has never had a colonoscopy. she has no history of thyoid dysfunction. . in the ed, the patient's vital signs were t 97.3, bp 123/88, hr 118, o2 sat 97% on ra. exam notable for decreased breath sounds bilaterally, le edema. ekg borderline low voltage, no evidence of ischemia. labs are unremarkable. cxr with bilateral effusions. bedside echo with significant pericardial effusion, no evidence of tamponade (unreliable). the patient is admitted to for work up and evaluation of pericardial effusion. . the patient remianed stable on the floor. a formal tte was acquired, which confirmed a pericardial effusion, but also demonstrated evidence of rv collapse. her pulsus as taken by the team was . the decision was made to transfer the patient to the ccu for continued monitoring. . . on review of systems, she 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. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for chest pain, dyspnea on exertion, orthopnea, ankle edema, palpitations. she denies paroxysmal nocturnal dyspnea, syncope or presyncope. . past medical history: 1. osteopenia 2. basal cell carcinoma - left chest and nose 3. cataract surgery, l eye 4. gravida 6, para 6, nsvd x6. 5. status post tonsillectomy. 6. premature menopause in her late 30s or early 40s. . cardiac risk factors: (-)diabetes, (-)dyslipidemia, (-)hypertension . cardiac history: cabg: none. . percutaneous coronary intervention: none . pacemaker/icd: none. . other past history: none. . social history: social history is significant for the absence of current tobacco use. she drinks occasional wine with dinner. family history: there is no family history of premature coronary artery disease or sudden death. her father died of esophageal cancer, mother died at 92. she had a brother with melanoma and an aunt with liver cancer. . physical exam: vs bp 98/75, hr 90, rr 18, o2 sat 99% on ra, pulsus 4. gen: wdwn middle aged female in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp to angle of the jaw, no hjr. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, ? fix split s2. no m/g. no thrills, lifts. + rub. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. decreased breath sounds at bilateral bases. abd: soft, mild distenstion. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. no fluid wave. ext: 2+ bilateral le edema. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ pertinent results: ekg demonstrated normal sinus rhythm, normal axis, normal intervals, no st or tw changes and low volage. . telemetry demonstrated: nsr . 2d-echocardiogram: . the left atrium and right atrium are normal in cavity size. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are 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 no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is a moderate to large sized circumferential pericardial effusion measuring 1.5cm lateral to the lv, 1.8cm at the apex and anterior to the rv, and 2.8cm inferior to the lv. there is right atrial, right ventricular, and left atrial diastolic collapse, consistent with impaired fillling/tamponade physiology. impression: moderate to large circumferential pericardial effusion with echocardiographic evidence for hemodynamic compromise/tamponade physiology. . ett demonstrated: no prior etts . cardiac cath demonstrated: no history of cardiac catheterization. . other testing: cxr: mild cardiomegaly, bilateral pleural effusions, new since . . laboratory data: see below. ck 168 troponin <0.01 ck-mb 6 bnp 188 esr 4 tsh:2.4 . . . 09:00am blood wbc-5.3 rbc-4.19* hgb-13.3 hct-39.8 mcv-95 mch-31.8 mchc-33.5 rdw-13.7 plt ct-233 09:00am blood neuts-69.8 lymphs-22.4 monos-6.3 eos-1.1 baso-0.4 09:00am blood esr-4 09:00am blood glucose-83 urean-20 creat-0.7 na-142 k-4.2 cl-106 hco3-29 angap-11 04:45pm blood alt-49* ast-45* ld(ldh)-279* ck(cpk)-108 alkphos-88 totbili-0.3 04:30am blood lipase-21 09:00am blood ck-mb-6 probnp-188 09:00am blood ctropnt-<0.01 04:45pm blood ck-mb-4 ctropnt-<0.01 04:30am blood totprot-5.1* albumin-3.4 globuln-1.7* calcium-8.9 phos-3.8 mg-1.7 04:30am blood hapto-100 09:00am blood tsh-2.4 09:00am blood rheufac-6 crp-4.1 04:36pm blood -negative 05:03pm blood ca -9 -pnd . . pericardial fluid: 11:39am other body fluid wbc-2556* hct,fl-10.5* polys-27* lymphs-46* monos-0 eos-2* mesothe-1* macro-24* 11:39am other body fluid cd23-d cd45-d hla-dr 7-d kappa-d cd2-d cd7-d cd10-d cd19-d cd20-d lamba-d cd5-d 11:39am other body fluid cd3-d 11:39am other body fluid ipt-d 11:39am other body fluid totprot-3.9 glucose-83 ld(ldh)-1185 amylase-29 albumin-2.9 . . echocardiogram (): the left atrium and right atrium are normal in cavity size. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are 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 no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is a moderate to large sized circumferential pericardial effusion measuring 1.5cm lateral to the lv, 1.8cm at the apex and anterior to the rv, and 2.8cm inferior to the lv. there is right atrial, right ventricular, and left atrial diastolic collapse, consistent with impaired fillling/tamponade physiology. impression: moderate to large circumferential pericardial effusion with echocardiographic evidence for hemodynamic compromise/tamponade physiology. clinical correlation and serial evaluation are suggested. . pelvic ultrasound (): transabdominal and transvaginal ultrasound were performed, the latter to better evaluate the ovaries and endometrium. the uterus is anteverted and measures 5.3 x 2.5 x 3.9 cm. the uterine cavity is distended with fluid. the endometrium measures approximately 2mm. the left ovary is normal. the right ovary is not visualized. there is no hydronephrosis. there is a small amount of pelvic free fluid. targeted ultrasound in the area left of the umbilicus in the region of patient's tenderness shows no abnormality. impression: 1. fluid in the uterine cavity in postmenopausal female. recommend further evalution to exclude endometrial cancer. 2. the left ovary is normal. the right ovary is not visualized. no pelvic mass seen. 3. small amount of pelvic free fluid. . . ct of the chest without intravenous contrast (): bilateral pleural effusions are present, moderate on the right, small on the left. there is adjacent compressive atelectasis, with smaller areas of subsegmental atelectasis in the bilateral upper lobes adjacent to the fissures. no worrisome nodule or mass is identified, although lesions can be obscured in the regions of atelectatic lung, especially without intravenous contrast. the heart size is normal. there is a moderately large pericardial effusion. the thoracic aorta is normal caliber and contour. no mediastinal or axillary lymphadenopathy is appreciated. limited views of the upper abdomen shows periportal edema, fluid in the pancreatic-duodenal groove and left paracolic . note is made of either small calcifications or hemorrhagic products in the left renal cortex. impression: 1. bilateral pleural effusion and moderately large pericardial effusion with atelectasis. 2. body wall anasarca, periportal edema, and fluid in the pancreatic-duodenal groove/paracolic gutters, which may be relate to fluid overload or hypoalbuminemia. correlation is recommended. . . cardiac catheterization (): 1. pericardial tamponade. 2. drainage of 460cc of bloody fluid with improvement in hemodynamics. . . pericardial fluid cytology (): atypical. atypical cells, favor reactive mesothelial cells. abundant blood with macrophages and lymphocytes. . . echocardiogram (): left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets appear structurally normal with good leaflet excursion. the mitral valve leaflets are structurally normal. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , the pericardial effusion and tamponade physiology have resolved. . . echocardiogram (): the left atrium is normal in size. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the right ventricular cavity is mildly dilated with normal free wall contractility. there is abnormal septal motion/position. the number of aortic valve leaflets cannot be determined. the aortic valve is not well seen. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. pericardial constriction cannot be excluded. impression: trivial pericardial effusion without evidence of tamponade. there is a septal "bounce" seen on the sub-costal images. this may be due to a conduction abnormality or prior surgery but constriction cannot be excluded. compared with the prior study (images reviewed) of , the appearance of the effusion is similar. . . torso ct-scan (): chest findings: bilateral pleural effusions, moderately sized on the right and small on the left are unchanged from the previous study. subsequent to this is compressive atelectasis bilaterally. there is no suspicious pulmonary nodule or mass. the heart and great vessels are notable for a newly placed pericardial drain with interval decrease in the size of pericardial effusion, which is now trace in size. no mediastinal or axillary lymphadenopathy is visualized. abdominal findings: the spleen, adrenal glands, kidneys, pancreas, gallbladder, stomach, and proximal small bowel are unremarkable. there is no free gas in the abdomen. tiny low attenuating lesions (2:52) in segment ii and as well as in segment viii are too small to characterize, possibly hepatic cysts. there is no retroperitoneal or mesenteric lymphadenopathy. pelvic findings: a small amount of free fluid is seen in the pelvis. the bladder is distended and otherwise unremarkable. the uterus is unremarkable. the rectum and colon are normal. there is no pelvic or inguinal lymphadenopathy. osseous findings: degenerative changes are noted in the lower lumbar spine and there are no suspicious sclerotic or lytic osseous lesions. impression: 1. unchanged bilateral pleural effusions and decreased pericardial effusion following pericardial drain placement. 2. no evidence of neoplastic disease in the torso. . . cxr (): findings: the pericardial drain is present overlying cardiac contour. there is a moderate-to-large right pleural effusion. a small- to moderately- sized effusion is seen on the left. the left lower lobe opacity is most likely a combination of atelectasis and pleural effusion. the remainder of the lungs appears clear. the heart size is slightly smaller than on . impression: 1. moderate-to-large right-sided pleural effusion and small- to moderately-sized left pleural effusion, not significantly changed since ct torso of . 2. pericardial drain in place. . . brief hospital course: ms. is a 70 year old female with no significant medical history who presents with le edema and chest pain found to have bilateral pleural effusions and pericardial effusion with tamponade. . # pericardial effusion: the patient described worsening symptoms of lower extremity edema over the month leading up to her hospitalization, and was found to have a large pericardial effusion with tamponade physiology. this was felt to most likely be a sub-acute to chronic process. differential included idiopathic, malignant, uremic, post-mi, infectious (viral), autoimmune, and hypothyroidism, the most concerning diagnosis of which would be a malignant effusion. her tsh, bun, and creatinine were normal and there was no history to suggest an mi with normal cardiac enzymes x1. she also had a normal , rf, esr, but an elevated crp at 4. she is reportedly up-to-date on her malignancy screening, with the exception of a colonoscopy, and she has a ca -9 pending on discharge. there was no evidence of a pulmonary process on chest x-ray, and there was no history of recent viral uri other than an oral herpes lesion three months prior. she additionally had a pelvic ultrasound to investigate for gyn malignancy and torso ct to investigate for any malignant processes, which were both negative. she underwent a pericardiocentesis on , which revealed bloody fluid. this fluid was sent for analysis including cytology (reactive mesothelials), cell count / differential (large wbc), gram stain (pmns, no microorganisms), cultures (bacterial, fungal, viral, mycobacterial - pending on discharge). a pericardial drain was left in place, which continued to drain fluid for approximately 48hours before it was removed. no clear source of the effusion was identified, and the patient remained hemodynamically stable, with resolution of the pericardial effusion on repeat echocardiography. . # pleural effusions: the patient was also noted to have bilateral pleural effusions on imaging, the differential for which again includes heart failure and serositis that would also cause the concurrent pericardial effusion. the patient's bnp was normal and there was no evidence of chf on her chest imaging. autoimmune processes were evaluated with the above laboratory tests, which were normal. meig's syndrome was also considered given her constellation of symtpoms, but pelvic ultrasound ruled-out ovarian malignancy. finally, a viral etiology could be considered, but there was no history consistent with this. medications on admission: none. discharge medications: none. discharge disposition: home discharge diagnosis: primary diagnosis: - pericardial effusion with tamponade - pleural effusions discharge condition: afebrile, vital signs stable. discharge instructions: you were admitted to the ccu at for a pericardial effusion and tamponade. you were also noted to have pleural effusions. you had a pericardiocentesis done and a pericardial drain was left in place for drainage. this was removed after the drainage decreased. evaluation for the cause of the pericardial and pleural effusions has yet been unrevealing, including autoimmune studies, thyroid studies, ct-scans for malignancy, and cytology. there are a few remaining studies that are still pending on discharge, including ca -9 (a tumor marker) and flow cytometry from the pericardial fluid, which should be followed-up by your primary care physician. recommendation is that the next step in your evaluation be an upper endoscopy and evaluation by gastroenterology given your history of difficulty swallowing. you otherwise did very well during the hospitalization, and will need a follow-up echocardiogram in weeks and follow-up with cardiology in the coming month. . if you develop any recurrent symptoms or other concerning symptoms at home, including chest pain, shortness of breath, palpitations, fevers, chills, headache, dizziness, abdominal pain, vomiting or diarrhea, you should call your doctor or return to the emergency room for evaluation. followup instructions: upper endoscopy: thursday, , 9:00am - dr. . echocardiogram: , , 8:00am . cardiology: dr. - , , 2:20pm . pcp: . - tuesday, :10am procedure: pericardiocentesis right heart cardiac catheterization diagnoses: unspecified pleural effusion personal history of other malignant neoplasm of skin other specified diseases of pericardium disorder of bone and cartilage, unspecified acute pericarditis, unspecified cardiac tamponade cataract extraction status 

Answer: The patient is high likely exposed to