2133 The image is contrary to logic. How do you judge it?
The patient’s diagnosis was clear from the MRI scan. It was primary liver cancer.
There was a 3×4 cm lesion on the liver, while the gallbladder was intact. The wall of the gallbladder was not even rough, let alone gallstones.
Moreover, Zhao Wenhua did not insert just one promo, but two.
The first was a preoperative scan, and there was no iodophor in the lesion. The second scan showed that it was taken after an embolism surgery, and judging from the date, the surgery should have been performed a few days ago.
The latest scan showed that the internal part of the tumor was already necrotic, and the image of the needle path could still be seen. It should be that rheumaterfrequency dissolution had been performed after the thrombosis.
“It shouldn’t be gallstones.” Zheng Ren said with certainty.
After watching the film, he knew what Zhao Wenhua was struggling about.
Zhao Wenhua nodded.”Boss Zheng, there were no gallstones before the surgery. It had only been a few days, so it was impossible for a large number of gallstones to appear. This is a conventional logical judgment, but it’s true from the imaging. “
As he said that, he sighed helplessly.
Sometimes, there would be errors in scans and logical judgments, and most doctors would use objective scans as the final basis for judgment.
After all, X-ray images were objective. Otherwise, what was the point of doing an X-ray examination on the patient? And in many cases, thinking and logic were limited by the doctor’s own quality and level. It was even related to the environment, emotions, and other factors.
However, at Zhao Wenhua’s level, an objective image could only be one of the standards for reference. He would not believe in any objective image.
The more skilled a doctor was, the more problems they had to consider.
Every problem that couldn’t be solved logically could lead to a very rare situation, which could lead to the further deterioration of the patient’s condition and even lead to the death of the patient.
Even if there was a typical medical imaging diagnosis on the X-ray, he still needed to understand it.
This was also the reason why Zhao Wenhua was stunned when he saw the CT scan that had a “clear” diagnosis.
This was because he could only feel that there was a problem, but he could not overthrow the diagnosis of gallstones. The contradiction between the two made people have no choice.
“What about the other tests?” Zheng Ren said.
Lin Yuan was sitting at the side, writing a medical record. She was a little sleepy, but after hearing what boss Zheng said, she became more energetic.
This was the tone of a senior doctor. As the junior doctor at the bottom of boss Zheng’s Medical Group, he definitely had to run over and hand over the other laboratory tests that boss Zheng needed.
It was the same when he was at Harvard, and it was the same when he returned to 912.
However, Lin Yuan was stunned in the next second.
She saw Zhao Wenhua, one of the leading professors of the 912 Department of interventional services, run to the computer with a slight bow and print out all the patient’s examination reports.
The printer buzzed and spat out A4 papers one by one.
Lin Yuan looked at Zhao Wenhua in surprise. He saw that Zhao Wenhua was anxious. Every time the printer spat out a report, Zhao Wenhua would grab it in his hands.
Was there a need to?
Although boss Zheng usually did not like to joke and it was very painful to hit the radialis with hemostatic forceps on the operating table, he was still very kind.
Lin Yuan didn’t quite understand why professor Zhao Wenhua was acting so humbly. He was simply … More like a doctor than she was.
“Boss Zheng, look.” The first thing Zhao Wenhua did was to hold the problematic test report in his hand and blow on it to lower the temperature of the A4 paper.
As expected, the patient’s white blood cells were high, so were his heminowardenase and serum enzymes.
Low calcium blood, high blood sugar …
Zhao Wenhua was very experienced. He had done all the necessary examinations, so Zheng Ren was not picky.
“Does the patient have a history of diabetes?” Zheng Ren asked.
“No, I didn ‘t,” Zhao Wenhua answered immediately.
He did not have a history of diabetes, but his blood sugar was high, and his blood calcium was low. This was one of the clinical tests for typical acute pancreatitis.
Could it be a postoperative stress reaction that led to cholecystitis and acute pancreatitis? Zheng Ren flipped through the test report and thought to himself.
Even though he thought this way, he did not come to a simple and crude conclusion.
The patient’s test sheet and medical imaging examination clearly pointed to acute cholecystectomy and acute pancreatitis.
But!
He still couldn’t explain how so many mud-like stones came about.
If it were the kind of cholecystitis with rough gallbladder walls, Zheng Ren would probably give up on thinking about it. However, the gallbladder had developed from nothing to something, and a large number of mud-like stones had appeared in just a few days. No matter how he thought about it, something did not seem right.
Moreover, she was a postoperative patient. Even if she did not eat regularly, her family would take very good care of her and eat as much as possible.
Strange.
Zhao Wenhua looked at Zheng Ren with anticipation.
“Tell me about the patient’s condition,” Zheng Ren said calmly as he stood at the reading position, crossed his arms and rested his chin on his hands. He was looking at the scans seriously.
The young doctor from Zhao Wenhua’s group was about to say something when he was interrupted by Zhao Wenhua.
“It’s like this, boss Zheng,” Like a junior doctor, Zhao Wenhua started to report his medical history.
“The patient came to our hospital for treatment a week ago. The initial diagnosis was liver cancer, so I took the patient in after I went out of the clinic. Three days ago, he received interventional embolism treatment and radio frequency dissolution for liver cancer. There’s an image here, and it’s the one that was taken after interventional embolism was completed. “
Zheng Ren nodded, indicating that he understood.
“The patient’s recovery after the operation is not bad. This morning, he suddenly complained of severe abdominal pain. After the consultation, the Department of Hepatobiliary and Pancreatic Surgery’s diagnosis was the same. It is recommended that the patient be treated. “
“But I think there’s a problem when I look at the X-ray.” Zhao Wenhua was very cautious.”The patient’s current condition is not very good. The pain has not been relieved.”
“Did you give me the painkillers?”
“I didn’t give it up. There are some things I still don’t understand.”
Zheng Ren nodded.
If he gave her painkillers without understanding, he would be courting death.
It was wrong! When he was looking at the test report, there seemed to be a problem. He had just passed it by and didn’t pay much attention to it.
Zheng Ren picked up the test sheet again and looked at it one by one.
Very quickly, he discovered the problem. The patient’s blood test showed that he had a high number of white blood cells, which could be used as one of the auxiliary diagnostic evidence for cholecystitis and acute pancreatitis.
However, the patient’s hemoglobin level had dropped to 76 g/L, while the amount before the surgery was normal.
“Anemia? Professor Zhao, what are your thoughts?” Zheng Ren asked.
Zhao Wenhua shook his head in confusion.
Whether it was radio frequency meltdown or interventional embolism surgery, it would not cause anemia.
There was no need to talk about interventional embolism. A needle hole would be placed on the thigh artery, and a guide wire and a catheter would be inserted to perform embolism treatment in the blood vessel. Bleeding complications rarely occurred because embolism itself was one of the treatments to stop bleeding.
In the case of MRI scan, the needle was not thick, and it would be inserted into the liver. When the liver was removed after the MRI scan was performed, the needle would have to be heated to avoid the needle from moving.
While the tumor cells were killed, the puncture site would also be “burned”. Even if there was bleeding in the capillaries, the bleeding would stop as if it had been electrocuted.
He did not have anemia before the operation, and he did not have any during the first follow-up examination after the operation. He only started to show signs of progressive anemia in the early hours of the morning.
This was a very suspicious point.
……
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