code/test.ipynb

{
 "cells": [
  {
   "cell_type": "code",
   "execution_count": null,
   "id": "25745a03",
   "metadata": {},
   "outputs": [],
   "source": [
    "# /home/mshahidul/readctrl/data/translated_data/translation_wo_judge/multiclinsum_gs_train_en2bn_gemma(0_200).json\n",
    "import json\n",
    "with open(\"/home/mshahidul/readctrl/data/translated_data/translation_wo_judge/multiclinsum_gs_train_en2bn_gemma(0_200).json\", \"r\") as f:\n",
    "    data = json.load(f)\n",
    "\n",
    "for item in data:\n",
    "    \n",
    "\n",
    "\n"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 6,
   "id": "a170a10b",
   "metadata": {},
   "outputs": [
    {
     "data": {
      "text/plain": [
       "'14-year-old previously healthy adolescent who presented to the Primary Emergency Care Service (PEC) of Osorno with a 11-day history of a predominantly nocturnal irritative cough. Symptomatic treatment was indicated, evolving with dyspnoea and orthopnoea. He presented to the Emergency Department of the Osorno Base Hospital (OBH), with severe respiratory distress, intolerance to supine position, and abdominal pain. He was admitted to the Paediatric Intensive Care Unit (PICU), tachycardic, hypertensive, polypneic, oxygen saturation 96% with FiO2 35%, rosy, hydrated and well perfused, with flat jugular veins, small bilateral supraclavicular lymphadenopathies. The thorax was without retraction of soft tissue, maintained in a genupectoral position, with decreased pulmonary murmurs in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The soft abdomen was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and\\n\\nA nephrological evaluation was performed, which confirmed renal failure secondary to tumor lysis syndrome, without dialysis urgency and tendency to hypertension, with creatinine 1.54 mg/dL, phosphemia 11 mg/dL, without hypernatremia. It continued with hyperhydration, diuretic (furosemide) and antihypertensive (amlodipine). From the respiratory point of view, it presented oxygen requirement, with FIO2 35% by mask of Venturi, suspending this supply on the third day of admission. It evolved with episodes of psychomotor agitation, associated to the diagnosis in process, which was treated according to the institutional protocol of psychomotor agitation, with psychological and psychiatric support, with satisfactory evolution. On the third day of admission and treatment a CT scan of the thorax, abdomen and pelvis was performed with contrast, observing an increase in the size of the thymus, of homogeneous aspect, probably in the context of a lymphoproliferative process and findings suggestive of pulmonary thromboembolism. The angioCT of the thorax showed thrombosis of the jugular vein, extensive bilateral pleural effusion associated to atelectatic phenomena in both bases, with signs of medical bilateral nephrosis. Anticoagulation with enoxaparin (1 mg/kg dose, every 12 hours) was indicated for twenty days. Then the angioCT of control showed resolution of the thrombosis.On the fourth day of admission and treatment, a diagnostic and extension study was performed, which included, among others, a complete biochemical profile including lipid profile, granulopoietic hyperplasia of the bone marrow (myelogram), flow cytometry (bone marrow) in which no cells with a predominant clonal or neoplastic immunophenotype of haemological lineage were observed, flow cytometry in peripheral blood negative for neoplastic cells, cytological of pleural fluid negative for neoplastic cells, flow cytometry of pleural fluid without evidence of haemological neoplasia. It was presented to the paediatric oncological committee, highlighting that it was not possible to take a biopsy of the tumour given that the mediastinal mass disappeared with the cytoreductive treatment, assuming the diagnosis of lymphoblastic lymphoma by the clinical picture and the response to treatment, according to the PINDA 0516 protocol. This protocol contemplates in Induction IA eight doses of Lasp E. coli of 10,000 IU/m2. Having received seven doses of L-asp and with a cumulative dose of ninety thousand international units plus glucocorticoid (prednisone), presented a picture of decline, vomiting, abdominal pain and mild dehydration. There was suspicion of pancreatitis, which was ruled out by normal amylase/lipase values and normal hepatic tests. At that time it had plasma electrolyte profile with hyponatraemia of 126 mOsm/kg and urinary osmolality of 510 mOsm/kg, both normal values. With hyponatraemia and hypertriglyceridaemia, there was suspicion of RAM of pseudohyponatraemia secondary to hypertriglyceridaemia associated to L-asp. It was evaluated by Gastroenterology and Endocrinology, indicating a diet low in refined sugars and rich in fiber, fibrates (ciprofibrato 100 mg oral daily) and omega 3 (4 g oral daily), until triglyceride values of 300 mg/dL were achieved. Two weeks later the triglycerides had a value of 79 mg/dL. Ciprofibrato and omega3 were suspended, indicating prophylactic use associated to corticoid and L-asp treatment. A total of twelve doses of L-asp were completed with a cumulative dose of one hundred and eighty four thousand international units corresponding to the induction protocol. The suspicion of RAM was subjected to causality evaluation, with the modified Karch and Lasagna algorithm by WHO5, which resulted in “Definitive” RAM for the association of L-asp and Prednisone\\n'"
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