I can see the status bar

Chapter 821 See also tuberculosis
As a clinician with "rich experience in dealing with infectious diseases", Sun Lien's own vigilance is definitely the highest among ordinary clinicians.After roughly inquiring about the condition of the patient named Wei Aihua in front of him, the alarm bells in Sun Lien's mind finally stopped—she and Ji Xiuying had no intersection of activity tracks or locations, and her symptoms were also similar to Ji Xiuying's. Xiuying is different.

Wei Aihua's main symptom is cough, but it is not accompanied by fever.What really baffled the doctors of the affiliated hospital was Wei Aihua's lung slices.

From CT, Wei Aihua's lungs had multiple plaques and nodular negatives since two years ago.The receiving doctor at the time thought it should be pneumonia, so she was treated with antibiotics.During the hospitalization, Wei Aihua felt that his symptoms had improved.But a CT scan showed no signs of absorption of the lesions in her lungs.

The last CT scan was half a month ago.Wei Aihua was admitted to the Respiratory Medicine Department of the Affiliated Hospital, and he was rediagnosed according to pneumonia.But this time, not only did the results of the CT reexamination remain unchanged, but even more serious progress occurred.And Wei Aihua himself didn't feel that the cough had decreased—the frequency and frequency seemed to be the same as before the treatment.

Such a result surprised the doctors of the affiliated hospital.And the change in progress... made the doctors feel cold.

Wei Aihua had multiple patchy ground-glass opacities in both lungs, accompanied by interlobular septal thickening.These ground-glass opacities also showed a plaque-like "paving stone sign" on the border.

The paving stone sign is a very characteristic imaging finding of lung lesions.This may also be one of the most unfriendly imaging features for "tense phobia".It is an imaging feature resembling irregular paving stones due to interlobular septal thickening and interlobular septal line shadows superimposed on a ground-glass opaque background.

Many years ago, the paving stone sign was the classic lesion of alveolar proteinosis.It was also one of the first imaging changes to be used to describe alveolar proteinosis.However, with the gradual development of imaging, the understanding of this feature in the imaging department has become more and more detailed-in addition to alveolar proteinosis, pulmonary edema, Pneumocystis carinii infection, diffuse alveolar hemorrhage, and invasive mucinous adenocarcinoma etc. are likely to show this feature.

This is why the doctors in the Department of Respiratory Medicine of the Affiliated Hospital suddenly felt cold when they saw this change - Wei Aihua hadn't done the five inspections for infectious diseases when he was admitted to the hospital.She must not be HIV...

Fortunately, the five inspections for infectious diseases that were urgently added later proved that Wei Aihua was not a patient with acquired immunodeficiency syndrome.This also helped the doctors at the affiliated hospital rule out the suspicion that she had Pneumocystis carinii.

But this method of exclusion cannot help Wei Aihua relieve the pain.She is still coughing frequently.In the next half month, except for the last week where no antibacterial treatment was continued, Wei Aihua continued to undergo various examinations including blood, urine and stool routine, blood biochemistry, coagulation function, autoantibodies, ESR, and respiratory etiology examinations.All results were negative.

Because of concerns that it might be tuberculosis, the affiliated hospital also conducted three sputum smear tests on Wei Aihua.Blood anti-tuberculosis antibody, serum tuberculosis infection T cell detection is also negative.Even sputum cultures for common bacteria and fungi were negative.

The doctors at the affiliated hospital really had a headache after completing this step in the examination.And half a month of hospitalization time has come, continue to be hospitalized for examination...the social security side may think that this patient is over-medicated.Therefore, the doctors of the affiliated hospital recommended Zhou Xiufang Comprehensive Diagnostic Center of the Fourth Central Hospital to Wei Aihua.And also specifically named Sun Lien's name.

Wei Aihua, who had been tortured for almost three years, came to the Fourth Hospital with his last ray of hope, and was very "lucky" to meet Sun Lien in the afternoon when he was out for a visit.She originally thought that she would have to work hard to grab the expert number, but she never expected that as soon as she mentioned Sun Lien's name, the toll window would give out the first number in the afternoon.

And the registration fee was only ten yuan.Wei Aihua can hardly remember when was the last time he paid ten yuan to a specialist clinic - 20 years ago?As soon as he entered the clinic, Wei Aihua was surprised to find that this "expert" was actually a young man who was about the same age as his own son.If it weren't for the fact that the other party was really serious about seeing a doctor, and the deputy director of the affiliated hospital recommended it to her, she really planned to turn around and leave.

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"Well..." Although he was complaining in his heart that he had fallen into the trap of respiratory medicine recently, Sun Lien vaguely felt that...the aunt in front of him might not be a problem of respiratory medicine.

Although the lesion was indeed in the lungs, the prompt on the status bar made him see an interesting place.

"Lipid granuloma 20865.39.57" and "Pulmonary tuberculosis 12436.21.45".

Tuberculosis is very easy to understand, which means that a diagnosis has been made clear in the status column - Wei Aihua is infected with Mycobacterium tuberculosis.If combined, she does not have a fever, and all inspections do not support it.This also means that she is likely to be a latent infection.

Mycobacterium tuberculosis is a very elusive pathogen that exhibits a wide variety of symptoms and affects patients in a variety of ways.Among them, the most frustrating one is "occult tuberculosis infection".

This kind of patient does not have symptoms such as fever, night sweats, and morning cough that tuberculosis patients often have.It often hides and lurks in the human body for many years, and finally develops into diseases such as bone tuberculosis that require long-term treatment.

As for the related tests being negative... Anyway, it was tuberculosis, Sun Lien himself was not surprised at all.He no longer wanted to read the diagnostic protocol for tuberculosis—in short, “tuberculosis cannot be ruled out.”Any disease may be related to tuberculosis, and tuberculosis can show almost all types of symptoms.

But... what's going on with this lipogranuloma?Sun Lien has not dealt with too many respiratory patients, and he has never seen this kind of diagnosis description before.Even in the various diagnostic materials collected by Wu Youqian, there is no such description.

If analyzed in a purely literal sense, this may be a lesion caused by oil, but it may also be an abnormal immune result.

The essence of granuloma is an inflammation caused by a delayed hypersensitivity reaction.It is an aggregation of macrophages and their derivatives, possibly accompanied by other inflammatory cells.When macrophages and their evolved cells infiltrate and proliferate locally, these cells form well-defined nodular lesions—this is a granuloma.

Macrophages are phagocytic cells in the body that specialize in processing large foreign bodies and cell debris.They consist of two tissue forms, "fixed cells" and "free cells".In addition to being found in the blood, they are also found in loose connective tissue -- such as the alveoli.

If combined with the three words "lipidity", then it seems that the culprit of the disease has been portrayed accurately - this should be a kind of oil that has been inhaled into the lungs by the patient for a long time.

Sun Lien is very satisfied with his deduction, and he seems to have seen the hope of solving the diagnosis in the outpatient clinic.However, he immediately ushered in a disappointment.

"I don't usually cook..." Wei Aihua was a little surprised that Sun Lien would ask herself this question, but she still replied with some embarrassment, "I'm not very good at cooking, and my husband usually does the cooking. "

It's not the oil fume caused by cooking... Then what kind of oil is often inhaled by a middle-aged woman who can't cook?Sun Li'en frowned. The oil of unknown origin, and tuberculosis, which cannot be diagnosed by immunology...it's a little troublesome to add together.

　There is only one update today... I'm a little bit stuck today, I'll check the status tomorrow.

　　
　
(End of this chapter)