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: palpitations major surgical or invasive procedure: ivc filter history of present illness: mr. is a 57 year old male with a past medical history significant for cholangiocarcinoma (unresectable and s/p chemo w/ gemcitabine and cisplatin), hypertension, and recent gib (ischemic v. infectious colitis) who presents with svt to 180s from clinic. . the patient was in his usual state of health, with chronic abdominal pain, and was seen today in clinic by dr. for a third round of chemotherapy. while sitting in the chair in the waiting room, he felt his heart beat "fast." there he was found to have svt to 180s and was sent to the ed. his bp at the time was 102/60. he denies any chest pain, cough, shortness of breath, lightheadedness, nausea, or vomiting. at baseline, he ambulates independently and without dyspnea on exertion. of note, he also denies noticing any lower extremity edema, fevers, chills, diarrhea, constipation, melena or brbpr. he endorses ~30lb weight loss over the course of 3 months. . in the ed, initial vs were: hr in 170s. vagal maneuver was attempted and failed. he was given adenosine 6mg and converted to sinus tachycardia. he remained persistantly tachycardic to 120s and so a cta was done that showed bilateral subsegmental pes. his labs were notable for negative ce, leukocytosis of 12.4, hgb/hct 9.9/29.9. on exam he was guaiac neg. heme/onc was consulted and recommended heparin gtt without bolus. vs on transfer were: 109, 124/96, 25, 100% on 2l. . notably, he was recently hospitalized () for brbpr s/p colonoscopy significant for segmental colitis with biopsies suggestive of ischemic vs infectious colitis. on that admission, he developed a fever 2 days and ct scan showed likely colitis; he was treated with cipro, flagyl, and asacol (which was discontinued recently by dr. . he did not receive any blood products at that time, and his hct on discharge was 27. . review of sytems: (+) per hpi (-) denies fever, chills, night sweats. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness. denied nausea, vomiting, diarrhea, constipation. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: #. cholangiocarcinoma: - presented with abdominal pain and jaundice. percutaneous transhepatic cholangiography was performed on w/ malignant cells on brushing. - he was taken to operating , found to have extensive common hepatic involvement and extension into the liver duodenum as well as head of the pancreas and was unresectable. - he is s/p bilateral metallic biliary stent placement on (removed on ). - started palliative chemotherapy with gemcitobine and cisplatin (cycle 1 , cycle ends ) #. hypertension #. gi bleed: s/p sigmoidoscopy w/ ulcerated friable colon biopsy c/w ischemic type colitis. social history: he works in a restaurant. he moved to the usa 20 years ago. he is married with 5 kids, the oldest 33 years old. he speaks minimal english. wife speaks no english. children speak english well. he smoked 1 pack for many years but quit 20 years ago. he denies alcohol or illicit drug use. family history: no history of gi cancer. physical exam: vitals: bp 133/88 hr 104 rr 20 o2 100 2l o2 general: alert, oriented, laying in bed, conversant and following commands, in no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate, normal s1 + s2, no murmurs, rubs, gallops abdomen: surgical scar appreciated along ruq, abdomen mildly tense and tender to palpation at mid-epigastric area, no guarding/rebound tenderness and normal bowel sounds ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema, neg pain on dorsiflexion skin: no jaundice neuro: a&ox3, tongue midline, perrl, eomi, scm/trap, neg babinski, gait deferred pertinent results: cta 1. bilateral segmental and subsegmental pulmonary embolism without evidence of right heart strain. 2. nodular mural atheroma in the descending thoracic aorta with configuration worrisome for future embolization. 3. hypoenhancing infiltrative hepatic mass extending into the porta hepatis and left hepatic lobe compatible with known cholangiocarcinoma. associated biliary obstruction again noted. 4. increasing ascites with persistent multiple nodular peritoneal implants. 5. persistent pancreatic ductal dilation. echo the left atrium is normal in size. there is a 2x2 cm echodensity posterior to the left atrium (cine loop 52), probably in the posterior mediastinum. it is outside the heart and anatomically could be associated with the esophagus or the surrounding structures. 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 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 borderline pulmonary artery systolic hypertension. very small pericardial effusion. there is an anterior space which most likely represents a fat pad. there are no echocardiographic signs of tamponade. no right atrial or right ventricular diastolic collapse is seen. impression: very small pericardial effusion without signs of tamponade. normal global and regional biventricular systolic function. no pulmonary hypertension or clinically-significant valvular disease seen. probable extracardiac posterior mediastinal mass. compared with the prior study (images reviewed) of , cardiac findings are similar. the extracardiac mass was not appreciated on the prior study. findings discussed with dr. at 1650 hours on the day of the study. ultrasound le: occlusive dvt in one of the two right posterior tibial veins. r v patent. no other thrombus noted. admission labs: 02:25pm blood wbc-12.4*# rbc-3.25* hgb-9.9* hct-29.9* mcv-92 mch-30.5 mchc-33.1 rdw-16.5* plt ct-510* 02:25pm blood neuts-79.1* lymphs-14.9* monos-5.0 eos-0.4 baso-0.6 02:25pm blood pt-12.5 ptt-21.7* inr(pt)-1.1 02:25pm blood glucose-115* urean-10 creat-0.7 na-135 k-3.5 cl-101 hco3-28 angap-10 02:25pm blood ck(cpk)-50 05:56am blood alt-19 ast-32 ld(ldh)-219 alkphos-117 totbili-0.6 02:25pm blood calcium-8.9 phos-3.0 mg-2.3 discharge labs: 07:15am blood wbc-9.3 rbc-2.88* hgb-9.3* hct-27.1* mcv-94 mch-32.2* mchc-34.2 rdw-16.6* plt ct-282 06:45am blood neuts-69.8 lymphs-22.8 monos-5.6 eos-1.3 baso-0.4 06:10am blood pt-12.0 ptt-21.4* inr(pt)-1.0 07:15am blood glucose-92 urean-7 creat-0.5 na-136 k-3.7 cl-106 hco3-22 angap-12 06:10am blood alt-17 ast-23 alkphos-111 totbili-0.8 07:15am blood albumin-3.7 calcium-8.5 phos-3.5 mg-2.2 brief hospital course: 57m with cholangiocarcinoma (unresectable and s/p chemo w/ gemcitabine and cisplatin), hypertension, and recent gib (ischemic v. infectious colitis) who presents with svt to 180s from clinic and was found to have bilateral subsegmental pes and right le dvt. initially admitted to the icu for monitoring and then transferred to the oncology service. . # pulmonary embolism / dvt: patient was started on heparin gtt for bilateral subsegmental pe noted on cta and dvt on leni then switched to lovenox sq. she had ivc filter placed today due to hx of gi bleed and the risk of bleeding with anticoagulation. she tolerated the procedure well and had no signs of bleeding. all stools were guaiac negative. her hct was stable at 27 on the day of discharge. . #. history of brbpr / ischemic colitis: sigmoidoscopy sig for biopsies consistent with ischemic colitis though patient was also treated for possible infectious colitis. he was recently seen by his outpatient gi doctor, dr. , who stopped his asacol and has sent off stool cx for e. coli and c diff which were negative. as noted above she was guaiac negative and hct stayed stable. . . #. svt: likely avnrt/avrt with termination by adenosine. in the had a brief episodes of svt, but is currently in sinus. has had episodes of avnrt/avrt in the past controlled by metoprolol/amiodarone though these have been held since last admission, given concern for bleed. metoprolol was restarted on at higher dose at 25mg tid and was started on diltiazen 30mg qid (will change to long acting prior to discharge) for rate control. pt had short runs, only a few seconds of sinus tachycardia, asymptomatic. she also had aggressive electrolytes control. pe management as outlined above. . #. metastatic cholangiocarcinoma: preliminary read is concerning for progression of metastatic disease, increase size of hepatic mass, and worsening ascites. prior ct scan notable for sclerotic lesion in sacrum. prior head ct w/ multiple subcentimeter low density regions (likely small vessel disease) and no evidence of obvious mets. followed by dr. as outpatient and is currently undergoing palliative chemotherapy. pt also has increase in abdominal girth and fluid shift on exam consistant with ascitis. she had therapeutic tap with 1 l removed. she was continued on home meds including megace, pain management with dilaudid prn, antiemetics with compazine/zofran and ativan prn. . # fen: regular diet tolerating well, replete electrolytes prn. . # ppx: pain control with dilaudid prn, bowel regimen, dvt ppx lovenox . # comm: with patient # code: full # dispo: pending above medications on admission: docusate sodium 100 hydromorphone 2 mg q4hr prn msir 15 mg q12 prochlorperazine maleate 10 mg every 4-6 hours prn lorazepam 1 mg every 6-8 hours prn zofran odt 8 mg tablet, rapid dissolve every 6-8 hours as needed for nausea. megestrol 400 mg/10 ml (40 mg/ml) suspension sig: once a day. sennosides 8.6 mg discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. 3. lorazepam 1 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea, anxiety. 4. ondansetron 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 5. megestrol 40 mg tablet sig: one (1) tablet po bid (2 times a day). 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 7. metoprolol succinate 50 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po once a day. disp:*45 tablet sustained release 24 hr(s)* refills:*0* 8. diltiazem hcl 120 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). disp:*30 capsule, sustained release(s)* refills:*0* 9. morphine 15 mg tablet sustained release sig: one (1) tablet sustained release po twice a day. 10. dilaudid 2 mg tablet sig: one (1) tablet po every 4-6 hours as needed for pain. 11. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: cholangiocarcinoma bilateral subsegmental pe dvt avnrt/avrt discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: you were admitted to for a fast heart rate and you were found to have a pulmonary embolism and blood clot in your right leg. you were initially treated with anticoagulation (blood thining medication) and medication to decrease your heart rate. you had a filter placed in your vein to hopefully prevent clots from moving to your lungs. you did well after your procedure. you were also very uncomfortable due to fluid in your abdomen. you had fluid removed from your abdomen and you are feeling better. you also had episodes of increase heart rate and you were started on medication to lower your heart rate. we added the following medications to your regimen: -started you on metoprolol xl 75mg once daily -diltiazem 120mg orally once daily -omeprazole 20mg daily we have not made any changes to your other medications. you will need to follow-up tomorrow with oncology as listed belw and with cardiology for your fast heart rate. followup instructions: cardiology: you have an appointment with dr. on at 11:00 am on building , cardiology phone # oncology: you have an appointment with dr. tomorrow at 1:00pm on ( procedure: interruption of the vena cava diagnoses: other specified cardiac dysrhythmias other pulmonary embolism and infarction malignant neoplasm of intrahepatic bile ducts acute venous embolism and thrombosis of unspecified deep vessels of lower extremity 

Answer: The patient is high likely exposed to