Doctor's Life Simulator

Chapter 19 The Extremely Rare Cobb's Syndrome

While Qin Lang was looking at the materials, footsteps came from outside the meeting room, and it was Wu Youtu who walked in with the other two attending physicians.

The one on the left is a female doctor. She is Dr. Yu, the attending physician of the Pediatric Internal Medicine Department of No. [-] Municipal Hospital. She is a very senior doctor and is very experienced in the diagnosis and treatment of children.

The other man on the right is Dr. Zhang, the attending physician of neurosurgery. He is also very accomplished clinically and has a lot of surgical experience.

The two doctors have strong auras. It has to be said that any attending physician in the city's first hospital is very powerful.

Seeing the three attending physicians coming in, Qin Lang naturally got up and put down the materials.

Seeing Qin Lang, such a young doctor attended the conference, both Doctor Yu and Doctor Zhang were slightly surprised. Generally speaking, with Wu Youtu's habit, young doctors are never allowed to participate in the conference.

As a woman, Dr. Yu instinctively looked at the handsome little doctor in front of her, with a very soft and friendly smile on her face.

After all, he is a doctor engaged in pediatrics, and he is like a spring breeze, but his heart is impregnable.

There is a saying in the medical field, called: golden ophthalmology, silver surgery, exhausted obstetrics and gynecology, greasy and crooked internal medicine, worthless pediatrics, never go to the emergency department if you die!
Qin Lang also smiled at Doctor Yu's gentle gaze, and guided the two doctors to their respective seats.

"You two, please take a look at the patient's condition first. After a while, Zhong Chengfa's attending doctor will arrive, and we will start the formal consultation."

Wu Youtu sat down at the host's seat, and then signaled in a low voice that Qin Lang sat next to him:

"Listen to my report later, and cooperate with the projection. Then, while listening to the analysis of the attending physicians, sort out the minutes of the meeting."

Qin Lang nodded, and naturally understood that this was a very good learning opportunity given to him by Wu Youtu.

Qin Lang also wanted to know what the cause of this little girl was, and seeing her suffer from the pain was also very uncomfortable.

After a while, Zhong Chengfa also rushed to the conference room, and after signaling to Dr. Zhang and Dr. Yu, he sat down and saw Qin Lang very kindly:

"Xiao Qin, I will also participate in the discussion later. If you have any ideas, you can mention them."

Regarding Zhong Chengfa's attitude, the two attending physicians on the side were a little strange. When did Zhong Chengfa treat the little doctor so amiably.

Could it be that this little doctor has a strong background and an extraordinary relationship?
Not enough, they don't have the time to guess Qin Lang's identity now, and they still put all their attention on the patient's condition, which is really puzzling.

When Wu Youtu saw that everyone was present, he also started this multi-disciplinary consultation.

"The specific situation must have been seen by several of you. Here are some latest photos and medical examination materials."

Wu Youtu sent the latest photos to Qin Lang through his mobile phone, and asked him to play them through the projection.

The three attending physicians also looked at it. The little girl is only over two months old now. It is very intuitive that there are obvious subcutaneous pigmentation on the back and adjacent areas, as well as obvious vascular moles.

This is also the reason why the treating physician judged it to be a hemangioma.

Wu Youtu pointed to the latest physical examination and pathology slides:
"Due to the sudden exacerbation of the condition, it is clear that the previous simple diagnosis of hemangioma is untenable. Two days ago, I made a pathological section on her, which showed that the patient had lipoma-like tissue, blood vessels and tumor-like hyperplasia of fat tissue. Striated muscle and nerve tissue can be seen."

Qin Lang cooperated with Wu Youtu's words, constantly switching and zooming in on the photos and details.

"Ulceration of the perineum has occurred due to irritants such as feces, urine, friction and maceration."

As the photos were played, the atmosphere in the conference room became more and more serious.

Dr. Zhang from the Department of Neurosurgery was the first to ask:

"Wu Zhizhi, now only relying on the preliminary physical examination, we can't draw a specific conclusion. I suggest another MRI!"

Of course, Wu Youtu had thought of Dr. Zhang's suggestion.

"Because it was considered to be a simple hemangioma before, and the symptoms were relatively mild, so I considered an MRI examination after 4 months."

"After all, the patient is still a baby. MRI is expensive and time-consuming, and the baby is difficult to cooperate with. So I first considered giving her an ultrasound examination of the skin and spinal cord."

Wu Youtu's thinking, of course, has his reasons, but ultrasonography is only a temporary method after all, and the rate of missed diagnosis is high.

However, this is the only way to do it now, and several people checked the latest ultrasound results together.

"Everyone, is it possible that it is a lipoma, or a space-occupying lesion in the spinal canal?"

Dr. Yu from the Department of Pediatric Internal Medicine at the side put forward her opinion, and I have to say that it is still very possible.

"Looking at the results of the ultrasound examination, you can roughly see that there is a hemangioma next to the spinal canal of the patient, and the vertebral body has bone destruction, with reduced density and unclear structure."

Dr. Yu's ability to read films is very strong, and he is well-known in the whole city's first hospital, which is one of the reasons why Wu Youtu invited her here.

"Look, the dilated aneurysm and venous lake in the patient's spinal cord squeeze and displace the spinal cord, which seems to be a space-occupying lesion."

Listening to Dr. Yu's analysis, both Dr. Zhang and Wu Youtu zoomed in on the film and examined it carefully.

"Yes, as expected of Dr. Yu, it is very likely that it is a space-occupying lesion in the spinal canal."

Doctor Zhang's spirit is also relaxed a little, as long as he has a general direction, he can follow this inference and find further evidence.

"Now that the direction has been preliminarily determined, let's go for an MRI!"

Wu Youtu nodded: "Okay, then first consider the treatment plan according to the space-occupying lesion in the spinal canal, and conduct MRI examination at the same time."

After having a direction, everyone finally felt a little better.

Qin Lang has also become a lot more relaxed from being nervous. Watching so many consultations with attending physicians has really taught him a lot. At the same time, he is also full of longing. When will he be able to treat patients like this? Make a diagnosis, cure the disease with medicine!

Just as the meeting was coming to an end, a familiar electronic voice suddenly sounded in Qin Lang's mind:
[New task: use life simulation to discover the real cause of the patient, and at the same time guide several attending doctors to give the correct treatment direction.Prevent patients from missing the best opportunity for treatment due to misdiagnosis.Task reward: 2 life simulation points. 】

[Do you want to enable simulation for a single patient? 】

Hearing this voice, Qin Lang's face naturally changed. He didn't expect that there would be a multi-department consultation. So many attending physicians would still diagnose in the wrong direction.

Qin Lang lowered his head and started the simulation:

[You were invited by Wu Youtu to participate in a multidisciplinary consultation. At the meeting, several attending physicians gave a wrong treatment plan because the patient's symptoms were too rare and were misled by the superficial symptoms. 】

[Three days later, the MRI examination report came out, but because several people were limited by their own thinking, they only noticed the diseases that supported the spinal canal space-occupying lesions, while ignoring several other hidden diseases.So according to the wrong treatment plan, the patient has been cured for a long time, and two months later, the patient has abnormal bleeding and blood stealing]

[After three months, the patient died.The patient's family made a big disturbance in the hospital, and Wu Youtu and others were very depressed and uncomfortable.Through the late symptoms before the patient died, Dr. Yu discovered the truth of the patient's death.The real cause of the patient is the extremely rare Cobb's syndrome! 】

[After the incident, Wu Youtu organized physicians in the department to jointly analyze the case, and gave the basis for judging Cobb's syndrome, as long as there are 5 of the following 3 items: (1) Skin or subcutaneous tissue hemangioma, brown skin Moles or flaky coffee spots, and may be accompanied by other congenital malformations, such as double-stem spinal cord, butterfly vertebra or meningocele; (2) vertebral hemangioma; (3) paravertebral hemangioma; (4) spinal canal Epidural hemangioma; (5) Intramedullary vascular malformation. 】

[At the same time, it is also proposed that spinal cord angiography is the gold standard for the diagnosis of this disease, which can comprehensively display the location, volume, flow velocity, feeding artery and draining vein of the malformed vessel, as well as the relationship between the malformation and adjacent vascular structures (especially spinal cord vessels), The source of blood supply and venous drainage of malformed blood vessels, etc.]

[End of single case simulation: You will gain experience in the diagnosis of Cobb's syndrome. 】

In the entire conference room, when everyone stood up and began to tidy up, a sudden voice sounded:
"Chief Wu, fellow physicians, I have another idea, and I want to share it with you!"

(End of this chapter)