Chapter 35 Tricky Cases, Unbelievable Causes
There are indeed patches, nodules and cord shadows on the young man's chest CT film.
This is considered a manifestation of tuberculosis.
But not typical enough!
More definite tuberculomas, or old tuberculosis lesions, calcifications, etc., cannot be seen.
"Waiting for sputum smear culture."
Chest CT can only be used as a preliminary screening.
The gold standard for tuberculosis is the discovery of Mycobacterium tuberculosis in sputum.
Soon after, the results of the patient's sputum culture came out.
No acid-fast bacilli were found.
At this time, Dr. Gu from the laboratory department called and said gently: "Dr. Xu, although this patient is negative for Mycobacterium tuberculosis, it cannot be ruled out...Clinically, Mycobacterium tuberculosis can only be found among tuberculosis patients. Twenty percent.”
Xu Qiu did not refute.
Indeed, the Mycobacterium tuberculosis bacilli are hidden deep in most people and will not be excreted into the sputum from the bronchi, so sputum culture may not find anything.
At this point in the diagnosis, the average doctor may have chosen diagnostic anti-tuberculosis treatment.
Right now--
Although there is not enough evidence to confirm tuberculosis,
But to be on the safe side, give anti-tuberculosis drug treatment first.
If valid, the diagnosis is established.
Otherwise, consider other diseases.
Xu Qiu did not do this.
The course of anti-tuberculosis treatment is often measured in months or half a year. If it is wrong, it will delay the disease too much.
"The condition is still unclear now. I suggest another bronchoscopy." Xu Qiu said.
The young man frowned.
He was a little dissatisfied with the repeated inspections.
But when he saw a beautiful female doctor next to Xu Qiu, he stiffened his neck and nodded: "It's a small problem. You can cure my disease for any amount of money."
After the patient left, Xu Qiu looked back at Chen Qiao.
Unexpectedly, interns have such a use.
Chen Qiao still didn't understand why, so he tilted his head and said, "Teacher, what's wrong?"
"It's okay, let's go to the next patient."
…
Bronchoscopy is a scary examination item.
The mirror passes through the patient's nasal cavity, enters the throat, turns into the airway, and finally penetrates into the lungs to directly obtain the diseased tissue, secretions, etc. in the lungs.
Through this check,
Doctors can also directly find the Mycobacterium tuberculosis bacilli hidden deep inside.
If this test is still negative, tuberculosis can basically be ruled out.
Unfortunately……
This time still no Mycobacterium tuberculosis was found!
The patient is anxious.
I coughed a few more times, and this time in addition to phlegm, there was also blood...
His face turned pale and he said: "Doctor, can you do it?
If it doesn't work, I'll fly to Tiandu to find an expert to check! "
Xu Qiu remained calm, but felt strange in her heart.
Did the disease develop so quickly?
It’s not pneumonia, it’s not tuberculosis, what else could it be?
The patient does not have symptoms such as heart failure.
"Where's the previous chest X-ray?"
Chen Qiao quickly found it.
Xu Qiu took it and compared it carefully against the light.
Suddenly, his pupils shrank.
There are many infection lesions in the patient's lungs.
It can even be described as a complete mess!
However, there is a very strange phenomenon in the lower lobe of the right lung——
The infections there are surprisingly neat.
It's like throwing a bunch of beans on the ground.
Logically speaking, it should be said to be chaotic and disorderly.
However, at this moment, some of the chaotic beans formed a long line.
Very inconspicuous, but it exists!
"Straight line infection?"
An idea popped into Xu Qiu's mind.
He glanced at the tattoo on the other person's arm and asked, "Have you been injured?"
The young man was stunned for a moment, with a surprised look on his face, and said, "Can you see that?"
He said: "One time I went out to have a barbecue. After drinking too much, I got into a fight with the table next door. Those bastards couldn't beat me at all!"
barbecue?
Bamboo stick!
Xu Qiu already had the answer in her mind, and said, "Get a chest enhanced CT and then do a three-dimensional reconstruction. It's a bit expensive, is that okay?"
The young man said scornfully: "Just check it out, there's no shortage of money!"
After the patient left, Chen Qiao said with emotion: "The teacher is so awesome. He checks whatever he asks, and the patient doesn't have any opinions at all!"
Xu Qiu glanced at Chen Qiao.
It seems that this girl doesn't know how lethal she is to men.
…
Before leaving get off work, the patient came back with the examination for the third time.
In the three-dimensional reconstruction, you can see that the patient's lungs have a long and thin shadow running across them!
The young man was frightened and said, "Doctor, what is this thing!"
Xu Qiu did not answer, but asked calmly: "Did your coughing start after that fight?"
"It seems so, I don't have any impression."
"This thing, if I guess correctly, should be a bamboo skewer for barbecue."
The young man's face suddenly turned pale, and he was startled and said: "It seems...it seems that someone really stabbed him everywhere with bamboo sticks at that time!"
Xu Qiu nodded.
now it's right.
Bamboo sticks are made of wood and are difficult to visualize on CT and enhanced CT, so they cannot be found at all.
If the bacteria had not adhered to the swab and created a linear "infection line", I'm afraid the patient's true cause would have been found only in the autopsy.
The patient was frightened and said, "Doctor, how could it be a bamboo stick? How could I not know if such a long stick was inserted into it?"
Xu Qiu explained: “The internal organs are different from the skin.
The internal organs have very few sensory fibers and are very insensitive to stimulation such as stinging and cutting.
On the contrary, it is very sensitive to traction, expansion, cold and heat, ischemia, etc. "
This is why——
Every time during abdominal surgery, Xu Qiu would remind him, "We need to explore."
This is because the warmth and pulling of hands can cause a violent reaction in the gastrointestinal tract, which is likely to cause the patient to vomit unconsciously.
Resulting in death from suffocation.
This requires anesthesiologists to maintain a high level of vigilance.
Xu Qiu guessed: "You must have been very drunk at the time, so you didn't feel the bamboo stick being inserted into your lungs.
During the subsequent fight, the bamboo stick was completely submerged.
When he woke up, only a small hole remained.
In addition, you can't feel your internal organs, so you don't realize that there is an extra bamboo stick in your body. "
The young man's expression changed again and again, and he said, "What should we do now?"
Xu Qiudao: "The only treatment option now is to open the chest and take it out.
If it is not removed, the inflammation will remain.
After repeated infections, sepsis may develop, causing right heart failure.
Once that step is reached, there is no chance of surgery. "
"Doctor, I need to have an operation, please save me!"
The young man realized the seriousness and was hospitalized immediately.
…
On the day the patient was admitted, news of the bamboo stick man spread throughout the emergency department.
Directors He Hai and Wang Ping were speechless.
He Haidao: "Such a tricky case was diagnosed on the same day?"
Directors of other departments said:
“There was a patient before who had a similar situation to this. After three years of diagnostic anti-tuberculosis treatment, it turned out that he had fish bones lodged in his lungs.
It can't be found out either.
In the end, the right heart function became insufficient, and there was no chance for surgery. All I could do was wait for death! "
Wang Ping became happier as he watched.
Xu Qiu is awesome, and he, as the future mentor, is also very honorable!
but,
When the patient is admitted to the hospital and further diagnosed.
A question that made everyone worried!
