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: shortness of breath major surgical or invasive procedure: 1. intubation and mechanical ventilation. 2. placement of 2 pleurex catheters history of present illness: 86f history of dm2, htn, hld, cardiac problem, transferred from . pt presented with one month of breathing difficulty, weight loss, cough, decreased apetite getting progressively worse over time. family trie to bring pt in earlier but she refused to go to hospital. last night pt became acute more sob and family called ambulance and pt brought to . at found to have wbc 44, hr 170's in a fib, lactate=4; concern for possible malignant process and ? pe. got dilt 30mg po and 10mg iv for hr, which improved. also got 4l ivf. leni showed r dvt. got head ct which showed nothing acute. deferred cta chest due to elevated cr (cr 1.8). started on heparin gtt for dvt and concern for pe. got azithro and ceftriaxone at . during transport pt developed worsened rales/crackles possibly secondary to 4 l ivf given. . in the ed, initial vs were: 65, rr 32, 128/59, 97% 15l nrb. ecg showed afib with rvr. patient was started on a nitro gtt, heparin gtt, given vancomycin/zosyn, and placed on bipap for resp distress which didnt tolerate. labs were notable for a lactate of 8.5, wbc count 49.3, inr 1.6 and cr of 1.8. cxr: air fluid level abscess in lung. patient was initially trialed on bipap, did not tolerate, and thus was intubated (straight forward intubation). placed r ij. cvp=13. lactate rose to 10 and concern for gut ischemia. cta chest and torso: no pe, revealed multiple abscess in l lung- rim enhancing fluid collection. multiple hypodensisities in kidney and liver suggestive of embolic infectious process. in ed given: vanco, zosyn, flagyl. thoracics consult: poor surgical candidate. recc drainage per ir right now. k=6-->insulin/d50, kayexlate. gave 1 uprbc for elevated lactate. ed attempted to call family several times to give update, never got through. . on arrival to the micu, pt is intubated, sedated, on levo 0.2 and dopamine 8. had family meeting with son and 3 grandchildren. family very tearful, as of now they request full code but will continue to discuss goals of care. they report this pt is usualy active at baseline, ambulatory, takes care of her great grandchildren. past medical history: dm2 htn hld cardiac process- seen at hospital, family is not sure what process this is. social history: lives with son, normally active at baseline and babysits grandchildren. ambulatory. rarely admitted to the hospital. no history of smoking or drug use. family history: no cancers. physical exam: vitals:t 98.1, hr 83, bp 110/51, a fib, 98% on ac fio2 40, tv 350, f 20, peep 5, mv 8.2. ivf in: 6l plus 1 prbc. uo: 230 in and 180 in ed. general: sedated heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: irregular rate, no mrg. lungs: anterior breath sounds, no crackles, few ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: sedated pertinent results: cytology negative for malignant cells. acellular specimen with bacterial overgrowth; correlate with microbiology report. ecg study date of 2:29:44 am the rhythm is regular and most likely a junctional escape rhythm at 60 beats per minute without clear atrial activity. delayed r wave transition. no previous tracing available for comparison. possible prior anteroseptal myocardial infarction. chest (portable ap) study date of 2:45 am findings: there is extensive opacification of the left hemithorax with an air-fluid level identified superiorly. these findings are representative of a large mass, possibly abscess in a fissure. less likely would be a large hiatal hernia. there is rightward shift of normally midline structures. otherwise, the right hemithorax appears clear. no acute fractures are identified. a dedicated chest ct is recommended for further evaluation portable tte (complete) done at 12:03:01 pm final the left atrium is elongated. no thrombus/mass is seen in the body of the left atrium. the right atrium is markedly dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is at least 15 mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity is unusually small. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular free wall is hypertrophied. the right ventricular cavity is mildly dilated with normal free wall contractility. there is abnormal diastolic septal motion/position consistent with right ventricular volume overload. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. no vegetation/mass is seen on the pulmonic valve. significant pulmonic regurgitation is seen. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade ct abd & pelvis with contrast study date of 3:05 am impression: 1. multilobulated large left hemithorax pleural empyema with foci of gas noted. given the foci of gas the differential includes recent instrumentation versus infection with a gas-forming organism versus a bronchopleural fistula. 2. multiple hypodense areas are also visualized throughout bilateral nonenlarged kidneys. these findings may be representative of multiple cysts but a superinfectious process with multiple abscesses cannot be excluded. 3. small subsegmental right upper lobe pulmonary emboli. 4. there is mild gallbladder wall edema and mottled apparance of the liver are likely due to congestive hepatopathy. 5. endotracheal tube with the tip at the level of the carina. retraction by 2cm is recommended. 6. bilateral small pleural effusions. 7 . severe cardiomegaly. cta chest w&w/o c&recons, non-coronary study date of 3:05 am impression: 1. multilobulated large left hemithorax pleural empyema with foci of gas noted. given the foci of gas the differential includes recent instrumentation versus infection with a gas-forming organism versus a bronchopleural fistula. 2. multiple hypodense areas are also visualized throughout bilateral nonenlarged kidneys. these findings may be representative of multiple cysts but a superinfectious process with multiple abscesses cannot be excluded. 3. small subsegmental right upper lobe pulmonary emboli. 4. there is mild gallbladder wall edema and mottled apparance of the liver are likely due to congestive hepatopathy. 5. endotracheal tube with the tip at the level of the carina. retraction by 2cm is recommended. 6. bilateral small pleural effusions. 7 . severe cardiomegaly. multiple cxr performed, representative reads shown. chest (portable ap) study date of 2:17 am findings: the left pigtail catheter is unchanged in position. the right ij and et tubes terminate in the standard position. the ng tube terminates outside the field of view. compared to , there are increasing bilateral pleural effusions, pulmonary vascular congestion, and parenchymal opacities suggesting developing pulmonary edema. cardiomegaly is unchanged. tere is no pneumothorax. findings were discussed by dr. with dr. by phone at 11:45 a.m. on . ct chest w/o contrast study date of 9:08 am impression: interval resolution of a dominant gas/fluid collection within the left hemithorax, and near-resolution of an adjacent medial collection. there remains a loculated posterior collection that does not appear tocommunicate with the catheter. 2. adjacent severe left lower lobe atelectasis with a consolidative component. slightly enlarged small right pleural effusion. trace pericardial effusion. new moderate anasarca. increased caliber of the main pulmonary artery likely reflects chronic pulmonary hypertension. . ct torso impression: 1. reaccumulation of left sided localized hydropneumothorax s/p pigtail catheter removal. 2. bilateral peribronchial ground glass opacity and patchy opacities which are a non-specific finding. 3. slight decrease in size of right pleural effusion. 4. stable increased diameter of the main pulmonary artery likely due to pulmonary hypertension. 5. persistent non-mobile 1.3cm filling defect within the left main bronchus which is suspicious for polyp, neoplasm or mucus plug. . ct chest impression: 1. mid-esophageal soft tissue mass severly narrows and may invade left main bronchus. 2. interval placement of a second left lower lung drain with interval decrease in size of the air and fluid collection. persistent left lower lung consolidation is either pneumonia or atelectasis. 3. markedly enlarged right atrium. 4. thinning of the renal cortices with hyperdensity which could represent retained contrast or nephrocalcinosis. . echo the left atrium is elongated. the right atrium is markedly dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 5-10 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is no ventricular septal defect. with borderline normal free wall function. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. an eccentric, posteriorly directed jet of mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is a very small pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. compared with the prior study (images reviewed) of , the degree of tr and pulmonary hypertension have increased. .. indications: 86-year-old female with esophageal cancer, lung empyema and ischemic right foot. bilateral lower extremity abis, doppler waveforms, and pvrs were performed at rest. findings: right: the right abi is 0.65 at dp. there is no signal present at pt. doppler waveforms are biphasic to the level of the popliteal artery. posterior tibial waveform is absent. the dorsalis pedis waveform is monophasic. pvrs are artifactually diminished proximally and aphasic at the metatarsal level suggesting severe tibial disease. the left abi is 0.61 at dp. the pt waveform is absent. left-sided doppler waveforms are triphasic at the popliteal level and monophasic at the dorsalis pedis. pvrs show significant dropoff between calf and ankle and again between ankle and metatarsal level suggesting severe tibial occlusive disease. impression: abis are likely falsely elevated. based on doppler waveforms and pvrs, there is severe tibial disease bilaterally. . comparison: ct and . technique: mdct data were acquired through the chest without intravenous contrast. images were displayed in multiple planes. findings: there are two pigtail catheters at the left lung base. a small-to-moderate effusion layers posteriorly. there is no large air-fluid collection in communication with the anterior or posterior drain. moderate left basilar atelectasis and/or consolidation is unchanged. a moderate right effusion is slightly larger. no new consolidation, nodule, or pneumothorax is present. since the prior exam, an esophageal catheter has been removed. the boundaries of a large mid esophageal mass are hard to delineate without contrast. the lesion measures approximately 1.9 x 3.4 cm (2:20). since the preceding exam five days ago, the left main bronchus has become completely effaced (2:20) by a combination of mass effect from the thickened esophagus, and bronchial secretions. there are extensive secretions in the distal left lower lobe segmental bronchus at (2:25). a tracheo-esophageal connection is not directly visualized but would not be suprising given the appearence. the non-contrast appearance of the heart and great vessels shows cardiomegaly, massive right atrial enlargment, and minimal aortic arch calcification. the tip of a right subclavian line terminates in the low svc. the thyroid has normal attenuation. no mesenteric, hilar or axillary adenopathy is present. there is residual renal excretion of contrast from . there are peripheral hyperdense foci in the visualized portions of both kidneys. previously, the cortices of both kidneys were uniformly hyperdense. residual oral contrast is seen in nondistended loops of large bowel. bones and soft tissues: there are no concerning lytic or sclerotic lesions. bilateral lower old rib fractures. there is diffuse soft tissue edema. impression: 1. large mid esophageal soft tissue mass with now complete opacification of the left main bronchus either by invasion, hemorrhage, and/or secretions. persistent post-obstructive left lower lobe consolidation and bronchial secretions. 2. improving small-to-moderate left pleural effusion. no large collection at the site of two pigtail catheters. 3. increasing moderate right effusion. 4. stable right atrial enlargement. final report chest radiograph indication: query pneumothorax, 86-year-old woman with large esophageal neoplasm extending into the left mainstem. technique: portable upright chest view was read in comparison with multiple prior radiographs with the most recent from . findings: lower lung opacity due to a combination of effusion and atelectasis now involves the entire left hemithorax suggestive of an increased large left pleural effusion. two pleural pigtail catheters in the left lower hemithorax are unchanged in position. increase in the left pleural effusion. there has not been much change in the position of the mediastinum probably due to associated left lung volume loss. moderate right pleural effusion and right basilar atelectasis is similar. upper lung is clear. impression: left pleural effusion has progressed over last two days. two left pleural pigtail catheters are in unchanged position and moderate right pleural effusion and bibasilar atelectasis is unchanged. the study and the report were reviewed by the staff radiologist. microbiology: 8:12 pm urine source: catheter. **final report ** urine culture (final ): no growth. 6:36 pm pleural fluid pleural fluid. gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (preliminary): no mycobacteria isolated. 4:40 pm fluid received in blood culture bottles site: pleural **final report ** fluid culture in bottles (final ): gram negative rod(s). refer to specime # 343-4776a . streptococcus anginosus (milleri) group. sensitivities performed on culture # 343-4776a . gram positive rods. refer to specimen # 343-4776a . anaerobic bottle gram stain (final ): gram negative rod(s). gram positive cocci in pairs and chains. gram positive rod(s). reported to and read back by on @ 740 pm. aerobic bottle gram stain (final ): gram negative rod(s). gram positive cocci in pairs and chains. gram positive rod(s). 3:30 am blood culture # 2. **final report ** blood culture, routine (final ): no growth. 04:08am blood wbc-11.3* rbc-3.46* hgb-10.0* hct-33.9* mcv-98 mch-28.9 mchc-29.6* rdw-22.8* plt ct-270 03:04am blood wbc-11.2* rbc-3.57* hgb-10.2* hct-34.7* mcv-97 mch-28.5 mchc-29.3* rdw-22.6* plt ct-286 05:06am blood wbc-8.9 rbc-3.28* hgb-9.3* hct-33.9* mcv-103* mch-28.3 mchc-27.3* rdw-23.0* plt ct-262 03:03pm blood wbc-10.5 rbc-3.60* hgb-10.1* hct-33.0* mcv-91 mch-28.1 mchc-30.7* rdw-22.6* plt ct-304 06:00am blood wbc-10.4 rbc-3.71* hgb-10.6* hct-34.8* mcv-94 mch-28.5 mchc-30.4* rdw-23.1* plt ct-299 03:25am blood wbc-13.3* rbc-3.75* hgb-10.6* hct-35.4* mcv-94 mch-28.2 mchc-29.9* rdw-24.0* plt ct-292 03:42am blood wbc-11.6* rbc-3.78* hgb-10.4* hct-34.4* mcv-91 mch-27.4 mchc-30.1* rdw-22.6* plt ct-305 03:25am blood wbc-13.3* rbc-3.75* hgb-10.6* hct-35.4* mcv-94 mch-28.2 mchc-29.9* rdw-24.0* plt ct-292 02:57am blood wbc-14.2* rbc-3.62* hgb-10.1* hct-33.7* mcv-93 mch-28.0 mchc-30.1* rdw-23.5* plt ct-265 03:48am blood wbc-20.4* rbc-3.62* hgb-10.3* hct-32.8* mcv-91 mch-28.5 mchc-31.4 rdw-22.2* plt ct-247 02:27am blood wbc-22.8* rbc-3.41* hgb-9.6* hct-30.1* mcv-88 mch-28.1 mchc-31.8 rdw-19.8* plt ct-226 02:20am blood wbc-23.5* rbc-3.86* hgb-10.9* hct-35.7* mcv-93 mch-28.2 mchc-30.5* rdw-19.6* plt ct-206 01:57am blood wbc-20.3* rbc-3.76* hgb-10.6* hct-34.2* mcv-91 mch-28.1 mchc-30.9* rdw-19.2* plt ct-180 03:04am blood wbc-22.3* rbc-3.85* hgb-10.7* hct-34.7* mcv-90 mch-27.7 mchc-30.7* rdw-18.6* plt ct-165 02:56am blood wbc-27.4* rbc-3.94* hgb-11.4* hct-35.6* mcv-90 mch-29.0 mchc-32.1 rdw-17.7* plt ct-175 03:22am blood wbc-24.2* rbc-4.21 hgb-11.7* hct-38.3 mcv-91 mch-27.8 mchc-30.5* rdw-17.4* plt ct-204 03:34am blood wbc-24.2* rbc-3.99* hgb-11.2* hct-35.4* mcv-89 mch-28.2 mchc-31.8 rdw-17.6* plt ct-212 01:10pm blood wbc-27.0* rbc-4.15* hgb-11.4* hct-37.2 mcv-90 mch-27.4 mchc-30.6* rdw-16.8* plt ct-310 04:24am blood wbc-24.9* rbc-3.96* hgb-11.0* hct-34.9* mcv-88 mch-27.8 mchc-31.6 rdw-17.2* plt ct-264 11:17pm blood wbc-23.3* rbc-3.85* hgb-10.3* hct-33.1* mcv-86 mch-26.8* mchc-31.2 rdw-16.3* plt ct-288 07:07pm blood wbc-28.8* rbc-3.31* hgb-9.3* hct-28.8* mcv-87 mch-28.0 mchc-32.3 rdw-16.0* plt ct-408 11:58pm blood wbc-36.1* rbc-4.10* hgb-11.0* hct-36.1 mcv-88 mch-26.7* mchc-30.3* rdw-15.9* plt ct-425 01:37pm blood wbc-48.5* rbc-3.99* hgb-10.5* hct-35.7* mcv-90 mch-26.3* mchc-29.3* rdw-15.4 plt ct-541* 10:41am blood wbc-46.5* rbc-3.79* hgb-9.8* hct-34.3* mcv-91 mch-25.9* mchc-28.6* rdw-15.0 plt ct-501* 08:20am blood wbc-44.7* rbc-3.74* hgb-9.9* hct-34.6* mcv-93 mch-26.5* mchc-28.7* rdw-15.0 plt ct-514* 02:45am blood wbc-49.3* rbc-3.71* hgb-9.7* hct-33.7* mcv-91 mch-26.2* mchc-28.8* rdw-15.2 plt ct-589* 02:45am blood neuts-85* bands-3 lymphs-4* monos-7 eos-0 baso-0 atyps-0 metas-1* myelos-0 08:20am blood neuts-95.9* lymphs-2.5* monos-1.2* eos-0 baso-0.4 03:34am blood neuts-90.9* lymphs-8.1* monos-0.5* eos-0.2 baso-0.2 03:22am blood neuts-93.0* lymphs-5.2* monos-1.0* eos-0.2 baso-0.6 04:08am blood pt-15.7* ptt-103.7* inr(pt)-1.5* 03:04am blood pt-14.4* ptt-33.5 inr(pt)-1.3* 05:06am blood pt-15.4* ptt-150* inr(pt)-1.4* 02:20am blood pt-14.4* ptt-87.4* inr(pt)-1.3* 09:30pm blood pt-12.8* ptt-103* inr(pt)-1.2* 05:10pm blood pt-12.6* ptt-150* inr(pt)-1.2* 01:37pm blood pt-18.0* ptt-28.7 inr(pt)-1.7* 04:08am blood glucose-115* urean-32* creat-1.4* na-141 k-4.3 cl-113* hco3-25 angap-7* 03:04am blood glucose-228* urean-33* creat-1.4* na-143 k-4.1 cl-114* hco3-25 angap-8 09:52am blood glucose-145* urean-34* creat-1.5* na-145 k-3.4 cl-115* hco3-24 angap-9 05:06am blood glucose-826* urean-30* creat-1.5* na-133 k-6.5* cl-105 hco3-21* angap-14 02:59pm blood creat-1.8* na-146* k-3.8 cl-114* hco3-22 angap-14 02:57am blood glucose-119* urean-54* creat-2.2* na-146* k-3.6 cl-114* hco3-24 angap-12 03:48am blood glucose-201* urean-61* creat-2.6* na-143 k-4.1 cl-114* hco3-20* angap-13 02:20am blood glucose-153* urean-54* creat-2.8* na-139 k-4.2 cl-106 hco3-20* angap-17 02:20am blood glucose-153* urean-54* creat-2.8* na-139 k-4.2 cl-106 hco3-20* angap-17 01:57am blood glucose-182* urean-51* creat-2.7* na-142 k-3.8 cl-110* hco3-21* angap-15 03:22am blood glucose-146* urean-43* creat-1.9* na-143 k-3.4 cl-113* hco3-19* angap-14 04:24am blood glucose-208* urean-48* creat-1.7* na-139 k-3.5 cl-111* hco3-16* angap-16 10:41am blood glucose-128* urean-56* creat-1.7* na-142 k-4.8 cl-112* hco3-15* angap-20 02:45am blood glucose-141* urean-60* creat-1.8* na-138 k-6.5* cl-109* hco3-13* angap-23* 05:32am blood alt-12 ast-16 alkphos-73 totbili-0.5 03:03pm blood alt-15 ast-18 ld(ldh)-261* amylase-129* 03:34am blood alt-88* ast-76* ld(ldh)-246 alkphos-201* totbili-0.8 04:24am blood alt-119* ast-206* ld(ldh)-320* alkphos-116* totbili-0.8 10:41am blood alt-111* ast-600* ld(ldh)-1689* alkphos-119* totbili-0.6 03:03pm blood ck-mb-4 ctropnt-0.04* 01:37pm blood ck-mb-4 ctropnt-0.04* 10:41am blood ck-mb-4 ctropnt-0.03* 08:20am blood ctropnt-0.03* 02:45am blood ctropnt-0.04* 04:08am blood calcium-8.1* phos-3.6 mg-2.0 03:04am blood calcium-8.2* phos-3.7 mg-2.0 02:45am blood albumin-2.3* 08:20am blood calcium-7.0* phos-6.6* mg-2.1 10:41am blood albumin-1.8* calcium-6.9* phos-5.1* mg-1.9 01:37pm blood calcium-7.4* phos-5.2* mg-2.1 uricacd-10.6* 01:37pm blood hapto-326* 10:02am blood vanco-9.5* 06:04pm blood vanco-15.4 07:07pm blood vanco-20.5* 08:10am blood vanco-18.5 05:43am blood vanco-22.8* 05:57am blood vanco-20.4* 06:00am blood vanco-18.9 05:32am blood vanco-24.9* 02:58am blood lactate-8.5* k-6.5* 04:44am blood glucose-124* lactate-9.6* k-6.2* 04:53am blood lactate-9.3* 06:22am blood lactate-9.6* 08:48am blood glucose-205* lactate-7.0* na-139 k-5.4* cl-113* calhco3-13* 11:12am blood lactate-4.7* 11:53pm blood lactate-2.9* 12:27pm blood lactate-2.7* 12:52am blood lactate-2.2* 09:16am blood lactate-2.7* 04:23pm blood lactate-2.4* 06:14pm blood lactate-2.1* 03:17pm blood lactate-1.7 03:37am blood lactate-1.5 04:17am blood lactate-2.1* 02:28am blood lactate-3.8* 10:01am blood lactate-5.4* 02:18pm blood lactate-4.4* 10:33am blood lactate-1.7 06:36pm pleural wbc-* rbc-* polys-98* lymphs-0 monos-1* meso-1* 06:21pm pleural wbc-1700* rbc-800* polys-75* lymphs-20* monos-0 baso-1* meso-1* other-3* 02:45am estgfr-using this brief hospital course: 86 yo f with no known medical problems admitted shortness and breath cough. hospital course was notable for admission to the icu where she was found to have lung and renal abscesses, septic shock requiring vasopressor support, dvt and pe, and difficult to control atrial fibrillation. she was also noted to have a large esophageal mass suggestive of esophageal cancer with compression of the left main stem bronchus causing intermittent lung collapse and esophageal compression with dysphagia/aspiration. patient had a long icu course and transferred from the floor to the icu multiple times. ultimately, given the patient's multiple significant and severe medical problems, age, and progressively declining course despite maximal medical care, a discussion was held with the family and the decision was to transition the patient's care to comfort centered care and the patient passed away at 2:10am. #septic shock/lung and renal abscesses: patient presented in septic shock from pneumonia with empyema and was found to have lung and renal abscesses. she required multiple pressors and intubation. her lactate peaked at 10. ct demonstrated multiple fluid collections as well as an esophageal mass (see below) that was compressing the l mainstem bronchus that was believed to be predisposing to her polymicrobial infection. interventional pulmonology placed two chest tubes to drain the fluid collections. gram stain showed gpcs, gnrs and gram positive rods. cultures only grew strep angionosis. she was initially treated with broad spectrum antibiotics but was weaned down to vancomycin and flagyl per id recommendations for a planned course of four weeks from the date of her last chest tube placement (day one ). she was weaned off pressors and succesfully extubated. she was treated with vanc/flagyl until she was made cmo on . #dvt/pe: patient was found to have dvt on lower extremity ultrasound. cta showed small subsegmental rll pe. patient was placed on heparin gtt. after her goals of care discussion anticoagulation was held on . #esophageal mass, likely esophageal cancer, with bronchial and esophageal obstruction: ct showed large mid esophageal soft tissue mass with now complete opacification of the left main bronchus either by invasion, hemorrhage, and/or secretions. there was persistent post-obstructive left lower lobe consolidation and bronchial secretions and patient did suffer collapse of her left lung. it was believed that this mass was the etiology of her polymicrobial septic shock, as well as persistent pleural effusions and left sided atelectatsis. secondary to the obstruction of the esophagus and risks for aspiratoin, the patient was made npo. she did transiently receive tpn, but this was discontinued when care was transitioned to comfort centered care. #atrial fibrillation: unclear if patient has history of afib, but this was likely exacerbated or caused by infection/sepsis. there may also have been contribution of irritation by esophageal mass. after hypotension resolved patient was managed on the medical floor with iv betablockers but required transfer back to the icu for rapid atrial fibrillation and low blood pressures in the 90s. she was subsequently rate controlled with iv amiodarone drip in the icu and transferred back to the medical floor. after family discussion regarding overall goals of care amiodarone was eventually discontinued. # acute renal failure: creatinine 1.8 with unclear baseline. her creatinine later increased to a peak of 2.8 which was believed to be atn from septic shock. her creatinine trended back down to 1.8. on the floor her creatinine remained at baseline. # anemia: she required 3 uprbc in setting of elevated lactate and septic shock. hct stabilzed in mid 30s. #goals of care discussion: throughout hospitalization multiple family meetings/updates were held with multiple providers/teams. palliative care was involved as were the social work and case management teams. with the patient's age of >80 years and multiple medical problems that continued to progress despite medical care (including iv amiodarone drip, tpn, antibiotics, and iv anticoagulation), the family decided to focus on comfort centered care on . the patient passed away on at 2am. medications on admission: none discharge medications: none discharge disposition: expired discharge diagnosis: 1. esophageal neoplasm 2. septic shock 3. atrial fibrillation 4. deep venous thrombosis 5. pulmonary emboli 6. digital necrosis of metatsarsals 7. occlusive narrowing of tibial arteries bilaterally 8. pleural effusions 9. pulmonary empyema discharge condition: expired procedure: insertion of intercostal catheter for drainage insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances arterial catheterization central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified acidosis hyperpotassemia anemia, unspecified acute kidney failure with lesion of tubular necrosis unspecified pleural effusion unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute and subacute necrosis of liver unspecified septicemia unspecified protein-calorie malnutrition severe sepsis atrial fibrillation pulmonary collapse other and unspecified hyperlipidemia septic shock abscess of lung do not resuscitate status encephalopathy, unspecified hyperosmolality and/or hypernatremia empyema without mention of fistula stricture and stenosis of esophagus tracheoesophageal fistula acute venous embolism and thrombosis of unspecified deep vessels of lower extremity streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group b renal and perinephric abscess malignant neoplasm of middle third of esophagus septic pulmonary embolism 

Answer: The patient is high likely exposed to