Chapter 795 Solving the Case

A genius doctor trained by his own hospital, and Yourong...

"It turned out to be retroperitoneal fibrosis?"

"It's a rare disease..."

"When I was studying at Union Medical College more than ten years ago, I treated a case of retroperitoneal fibrosis with the director at the time... Union Medical College had only seen three or four cases in total, and there were only about 40 or 50 cases that could be found in the domestic literature. about."

Everyone was sighing.

For rare diseases, you still have to go to Xu Qiu...

To rule out skin petechiae, many doctors may stop here.

But Xu Qiu was different. Based on the patient's various infection indicators, he continued to search for clues in the medical records, and finally found the word "constipation". Then he went back to the CT and found thickened retroperitoneal adipose tissue and fibrosis. Wait to confirm the diagnosis.

Who would have thought that constipation can indicate so many things?

The slight obstruction of the transverse colon that was ignored by the radiologist turned out to be an implicated reaction caused by retroperitoneal fibrosis...

However, after a brief shock, the directors straightened their sitting postures again.

This time the focus is not on retroabdominal fibrosis. In contrast, finding the main cause of dyspnea may be the key to solving the problem.

"It's not a lung infection..."

"What about hepatic encephalopathy?"

The director of the respiratory department looked at the film in his hand and analyzed: "The patient has liver cirrhosis and his physical condition is not good. He is a high-risk group for hepatic encephalopathy."

Wang Ping also nodded.

If there are liver cirrhosis and predisposing factors, it is very likely that dyspnea may be caused by hepatic encephalopathy.

But the director of the hepatobiliary department frowned and said: "It's too arbitrary. The patient's blood ammonia test and electroencephalogram were not checked, and there is not enough support for the conclusion."

He had seen a lot of hepatic encephalopathy.

According to the classification, mild cognitive impairment occurs in grade 1, and coma occurs only in grade 4 hepatic encephalopathy, the highest level.

However, many hepatic encephalopathies often do not reach grade 4 immediately, but slowly progress from grade 0 to the end, during which various manifestations will appear, such as asterixis, personality changes, disorientation, etc...

The patient suddenly lost consciousness and later developed difficulty breathing. Although it can be explained by hepatic encephalopathy, the onset process is not consistent with the progression of hepatic encephalopathy, and it can be ruled out with a high probability.

Xu Qiu nodded and agreed with the director of the hepatobiliary department.

Industry specializing in surgery……

Doctors in other departments did not have a deep understanding of hepatic encephalopathy. From a professional point of view, the chance that Xie Yunshi had hepatic encephalopathy was very small.

"Doctor Xu said it's not the case, so rule it out!"

"Head to head, it's not hepatic encephalopathy!"

The directors quickly changed the subject.

The director of the Hepatobiliary Department turned green... I analyzed a lot, and you all looked questioning. Dr. Xu nodded and you admitted your mistake!

The cardiologist thought for a long time and said, "So it seems like it's a heart problem?"

A large part of clinical dyspnea is acute heart failure.

Xu Qiu whispered: "Acute heart failure is mainly diagnosed by four conditions: dyspnea, B-type natriuretic peptide, electrocardiogram and echocardiogram performance."

Everyone hurriedly looked at the medical records, with expressions of surprise.

Completely suitable!

"It's acute heart failure!" the director of the cardiology department couldn't wait to give the conclusion.

However, this is only the general direction of causing dyspnea. What about the more detailed causes?

Is it acute decompensated heart failure, acute pulmonary edema, cardiogenic shock, or isolated right heart failure?

"Acute decompensated heart failure has one characteristic - the onset is gradual, but the patient's disease progresses rapidly and can be ruled out." The director of the Department of Cardiology shook his head.

Another cardiologist also said: “Although acute pulmonary edema develops rapidly, patients generally have increased afterload, left ventricular diastolic dysfunction and valvular disease. Although Xie Yunshi has mild symptoms of mitral and tricuspid valves, Insufficiency of regurgitation is not a factor in the pathogenesis of acute pulmonary edema.”

"Cardiogenic shock?" The doctor in the respiratory department felt a little headache.

If it is cardiogenic shock, the problem is very serious. This disease is generally related to acute coronary syndrome, cardiac tamponade, fulminant myocarditis, etc. Each of them is a serious illness that can kill people at any time.

"No, it's not." Xu Qiu called up a picture.

He said slowly: "Patients with cardiogenic shock usually have severe heart failure, but the patient is still young. Although his heart function is not as good as that of his peers, it is far from severe heart failure."

"Then..." Director Wang Ping of the emergency department changed his face slightly.

If it is not cardiogenic shock, it is most likely isolated right heart failure.

Acute pulmonary embolism is one of the common causes of isolated right heart failure. If it is caused by pulmonary embolism, it may be too late to rescue at this time...

Xu Qiu said calmly: "It is indeed isolated right heart failure. The good news is that it has nothing to do with acute pulmonary embolism. The real cause is pulmonary hypertension."

Pulmonary hypertension causes isolated right heart failure, leading to acute heart failure, and finally causes the patient to become comatose and have symptoms of dyspnea...

Link after link, the connection is extremely close.

Everyone was shocked.

But the doctor's careful thinking still made them aware that something was wrong.

The director of the cardiology department was the first to question: "But where does the patient's pulmonary hypertension come from?"

There are many causes of pulmonary hypertension, among which acute pulmonary embolism is an important pathogenic factor.

But this is easy to rule out. A pulmonary artery enhanced CT scan can make it clear.

Of course, there is also a simplest way to rule it out - the patient is still alive and well, and it is highly likely that it is not a pulmonary embolism that can kill in half an hour.

Then there are only two reasons left.

Lung disease and heart disease.

The former can be diagnosed by arterial blood gas and chest CT, and at best a CPET.

The latter heart has been diagnosed by cardiac ultrasound, electrocardiogram, etc.

The results have come out long ago, and the facts prove that the patient does not have serious lung disease, let alone heart disease that can cause pulmonary hypertension...

In this case, where does pulmonary hypertension come from?

Everyone present fell into deep thought.

Xu Qiu's previous diagnostic logic was very strict, and it can be said that there is nothing wrong with it.

The only flaw is that it cannot explain where pulmonary hypertension comes from!

"How about a cardiac catheterization?" Someone suggested.

Cardiac catheterization is an invasive examination that requires inserting a catheter that can test pressure into the femoral vein of the patient's leg. It is rarely used clinically.

But it is also the most intuitive means of testing pulmonary artery pressure, and it is also the gold standard.

Just like a sphygmomanometer, cardiac catheterization can also directly measure the pressure of the pulmonary artery, and it is clear at a glance whether it is pulmonary hypertension.

Xu Qiu ignored these suggestions and called up Xie Yunshi's patients.

At this moment, the conference room was quiet.