Chapter 174 Final diagnosis! A disease that was almost misdiagnosed
Perhaps, he and all the doctors were led astray in their diagnosis.
Both Xu Qiu himself and the discussion during the joint consultation overlooked one point.
Hepatosplenomegaly.
Everyone only regarded hepatosplenomegaly as malignant tumor infiltration or a chain reaction caused by other abnormalities.
but……
If hepatosplenomegaly is not incidental to the primary disease - it is the real cause!
After thinking about this, Xu Qiu suddenly had a feeling of enlightenment.
Since the primary disease cannot be found, why not regard such obvious hepatosplenomegaly as the culprit behind the disease?
…
In the ward, Luo's mother tucked Luo Qiao into bed. Just as she was about to coax her to sleep, she was startled by Xu Qiu who suddenly turned back.
"Doctor, what are you..."
Xu Qiu asked without any nonsense, "Has the patient come into contact with any animals before the onset of the disease last month?"
Mother Luo thought for a long time, and finally said with some embarrassment: "It's been too long, and I don't remember it."
Xu Qiu decided to be more direct: "For example, stray cats, stray dogs, or those who have been camping in the wild, etc."
"stray cat?"
Mother Luo said with some suspicion: "Yes, my child likes cats very much. I originally planned to buy one, but there are many stray cats in the community. I thought it would be better to adopt one than buy it, so I took one back."
stray cat!
At this moment, Xu Qiu felt a sense of enlightenment.
Previously, no one from lower-level hospitals or Linhai No. 1 Hospital asked the patient about his history of contact with stray cats.
Even Xu Qiu subconsciously thinks from a professional's perspective.
Although he realized that it might be related to cats and dogs, he did not ask directly. Instead, he simply did a test for Toxoplasma gondii.
Knowing this answer at this moment, it feels like a bright future.
"Doctor, is it related to that cat?" Luo Qiao's face suddenly looked very ugly.
Xu Qiu already had a guess in her mind, "It's almost the same."
After all, he ordered a test that no doctor had ever considered.
Minimally invasive laparoscopy!
…
Laparoscopy is now considered Xu Qiu’s strength.
After mastering a large amount of interventional experience and knowledge, as well as master-level laparoscopic surgery capabilities, he already has his own experience in laparoscopic surgery and exploration.
Therefore, Xu Qiu decided to do it himself during this laparoscopy.
This case is so tricky that it would have been easily missed by anyone else!
In the operating room.
After hearing that laparoscopy was required, doctors from the hematology department and orthopedic surgery department came over.
They still can't understand the decision.
The liver and spleen are not victims?
What is the use of examining an enlarged liver and spleen?
However, they knew that Xu Qiu often used strange tricks, and they were always effective, so they were even more surprised!
On the hospital bed, exploratory surgery is about to begin.
First, lie in the supine position, and adjust the automatic carbon dioxide pneumoperitoneum machine to inflate at a flow rate of 1 to 2 L per minute to establish artificial pneumoperitoneum.
Then adjust to the head-down-butt-high position, and perform routine disinfection and draping of the abdomen.
1% procaine 50-100ml was used for periumbilical block anesthesia and peritoneal surface anesthesia...
Make a small one-centimeter incision one centimeter from the edge of the umbilicus, going straight to the fascia...
Then lift the peritoneum and insert the puncture device along the skin incision!
boom!
boom!
After two breakthroughs, I successfully entered the abdominal cavity!
The pneumoperitoneum machine showed that the intra-abdominal pressure was 1.55kPa.
"Infuse 2L carbon dioxide."
Xu Qiu warned, and at the same time inserted the laparoscope, connected the light source, and began to explore the abdominal cavity.
Far first and then near.
No problems were found.
Xu Qiu focused on the liver.
Soon, a group of pink structures appeared on the screen, with bright red blood vessels running through them.
It's the liver.
"Nothing unusual..."
"Yes, except for the larger size, the shape, outline, and smoothness of the surface are all the same as normal people."
The doctors spoke, somewhat disappointed.
Xu Qiu's expression remained unchanged.
He trusts his own judgment.
Chichi——
Xu Qiu manipulated the laparoscope and carefully opened the liver lobe, intending to conduct a more thorough examination.
As a result, as soon as they opened the leaf, the picture on the screen shocked everyone.
"What's this!"
Under the liver lobes, there are white patchy nodules on the surface of the liver.
In addition, there are circles of black areas around it, which are focal necrosis.
Xu Qiu quickly gave a diagnosis.
White nodules: granulomatous inflammation
Black area: focal necrosis.
Both of these manifestations may occur in fungal, bacterial infections, and some rare parasitic diseases.
"But, infection has been ruled out..." The orthopedic surgeon was puzzled.
"Parasite infection?" The hematologist was a little unsure.
Xu Qiu took out the sample and asked the nurse to send it for pathological biopsy. At the same time, she said, "Well, parasites."
"Parasite? Hasn't the examination already ruled it out?"
Xu Qiu added: "To be precise, cat claw disease."
…
Cat claw disease is a rare infectious disease. It is mostly caused by the invasion of Bartonella into the human body after being bitten by fleas, ticks and other parasites.
For people in cities, the infection route is mostly through scratches and bites from stray cats and dogs, or accidental contact while camping in the forest.
The clinical manifestations of this disease are numerous.
Primary skin lesions, such as red papules, etc.
There are also local lymphadenopathy, fever, nausea, and conjunctivitis.
There are also many rare complications, such as encephalopathy, chronic organ failure, and joint damage!
There are too many symptoms, and there are many common manifestations of malignant tumors, so it is also easy to be misdiagnosed as a tumor!
If a PET-CT is really done, the patient's whole body bone density changes are clear, and it may really be regarded as a malignant tumor...
No one would have thought that there is also a cat's claw disease, which can also cause infiltration manifestations similar to malignant tumors!
Thinking of this, the doctors in the hematology and orthopedics departments were shocked and sweated.
Their diagnosis may really be wrong...
At this moment, they finally understood why Xu Qiu, who could perform a large number of difficult operations, personally went on this simple laparoscopic exploration.
If another doctor were to change, he might really miss the white nodules buried under the liver lobe!
That would completely miss the real cause of the disease!
...
Soon, the pathology department performed NGS sequencing on the specimens sent by Xu Qiu.
Finally, it was shown that there were 17 reads of Bartonella in the specimen, with a relative abundance of 1.9%.
Reads, or read length, is the base sequence obtained by a single sequencing of the sequencer, that is, a series of ATCGGGTA and the like.
The relative abundance can confirm whether there are other bacteria, parasites, etc. The smaller the relative abundance, the fewer species there are.
The relative abundance of 1.9% basically means that there are only Bartonella in the specimen.
When the results came out, many doctors were sweating.
So many doctors consulted, but it was almost a misdiagnosis!
If Xu Qiu hadn't insisted on his judgment, he would have done PET-CT and bone marrow biopsy later, which would have been a waste of effort!
"If it is confirmed to be Bartonella, I have another question..."
The director of orthopedics frowned, very confused, "Doctor Xu, in your recent physical examination, you found that the patient's lymph nodes were abnormally reduced-why is this?"
