medical road high rise

Chapter 462

Chapter 464

"The previous diagnosis was bronchial asthma, so why did a malignant segmental atelectasis in the right lower lung appear again?" Qin Feng asked.

Bronchial asthma is a chronic inflammation involving various cells, such as eosinophils, mast cells, T lymphocytes, etc., and cell components.

Symptoms such as wheezing, coughing, and chest tightness can all be related to bronchial asthma, but segmental atelectasis of the right lower lung cannot be explained.

Even after the development of bronchial asthma, it will not cause segmental atelectasis in the right lower lung.

Therefore, Qin Feng felt that the patient was not bronchial asthma at all, and the reason why the previous drug treatment relieved the patient's condition was because of the inherent side effects of the drug.

However, there is not much information in the patient's medical record. Most of the complaints, symptoms, and disease progression after medication are all fine. The only doubtful point seems to be the segmental atelectasis of the patient's lower right lung.

It's like a person with a basic heart disease. It's normal for him to have heart failure and heart disease, but suddenly he gets rheumatism, which is a bit abnormal.

"Let's arrange for the patient to be examined for segmental atelectasis in the right lower lung." Qin Feng said.

"But if there is no result, the patient will be dissatisfied." The thoracic surgeon said.

Because the patient has already had many examinations, and now the right lower lung is examined, the patient will definitely be dissatisfied.

Hospitals generally try to reduce the number of examinations for patients who seek medical treatment many times. As the thoracic surgeon said, if there is no result, it is easy to cause dissatisfaction among patients.

From the perspective of a thoracic surgeon, the examination is actually not necessary. After all, the atelectasis of the lower right segment is just a symptom that appears later, and the long-term cough of the previous patient has nothing to do with it.

Qin Feng shook his head and said, "No matter whether the results can be obtained or not, this examination must be done. The patient's segmental atelectasis in the right lower lung appeared too suddenly. There are only two situations now, or the patient has a new disease. , or it is a lesion that has been dormant for a long time, no matter which type, this examination is very necessary."

The thoracic surgeon nodded, he is still very convinced of Qin Feng in this respect.

However, to diagnose segmental atelectasis in the right lower lung, a bronchoscopy is required, that is, a slender bronchoscope is inserted into the patient's lower respiratory tract from the mouth or nose to directly observe the patient's trachea and bronchi. of lesions.

The patient was still a little bit resistant at first, and the thoracic surgeon was a little bit tongue-tied before allowing the patient to agree to the examination.

After checking, I found an abnormality.

The patient's right lower bronchus was blocked by a mass of fibrous and granulated tissue, which was also the root cause of the patient's right lower lung stage atelectasis.

What puzzled the thoracic surgeon was why a fibrous granulation suddenly grew out of the patient's healthy bronchi?
Granulations are generally caused by foreign matter irritating the airway, but the patient’s previous diagnosis was bronchial asthma, and it is impossible for foreign matter to invade, so how did the granulation occur?
After getting the results, the thoracic surgeon went back to the office to find Qin Feng.

Qin Feng was not surprised when he saw the result, it was what he was thinking.

Fibrous granulation is usually caused by long-term stimulation by foreign objects. This stimulation usually lasts for several months or even years. If this granulation existed long ago, then it should be related to the patient's cough and wheezing. Woke up.

"Prepare for the operation, let's peel off the granulation of the patient." Qin Feng said.

Since the granulation stripping operation is a minor operation, endoscopy can be done, so he found an observation room, and Qin Feng cut the granulation by himself, and then he could clearly see the foreign body in the patient's bronchus.

It was a fishbone, but now the fishbone is covered with yellow pus, and it is even connected with some tissues of the tube wall, showing faint signs of being integrated with the bronchial wall.

The thoracic surgeons gasped when they saw the image. They did not expect that the foreign body in the patient's bronchus was actually a fish bone, which they ignored during the examination.

Although medicine can provide temporary treatment, the patient's coughing and wheezing will never stop unless the fish bone is removed. It is no wonder that the patient has not been completely cured after so many years of treatment.

It turns out that the root cause of the disease has always remained in the patient's body, so how could it be cured?

Qin Feng thinks the most outrageous point is that this fishbone can be detected through imaging examinations, but in the past few years, various examinations of patients have skipped this fishbone.

Qin Feng carefully looked at the results of the chest CT examination of the patient, and found a problem.

It turns out that the fishbone in the patient's body belongs to the cartilage part of the fishbone. Even through imaging examination, it is difficult to show it in the film in the early stage.

It was not until the continuous development of fishbone, which stimulated the airway to produce granulation, that after bronchoscopy, it showed a performance similar to atelectasis in the lungs.

In other words, the patient did not have segmental atelectasis of the right lower lung, but simply got stuck fishbone and formed granulation, which led to a similar symptom of atelectasis.

The thoracic surgeon also lamented Qin Feng's careful observation. If he didn't insist on checking, he wouldn't be able to find this at all.

In fact, as a doctor of thoracic surgery, he has also seen many patients. For example, a child swallowed a plastic pen cap by mistake before, and he never dared to tell his parents. As a result, the pen cap stayed in his trachea for three or four years, and then he developed breathing problems. Difficulty, repeated infection and other symptoms led to severe atelectasis before it was discovered.

It's just that the pen cap is easier to detect than the fishbone. The thoracic surgeon expressed his gratitude to Qin Feng.

"Dr. Qin, thank you for your hard work this time."

"It's just a small matter, nothing else, I'll go first." Qin Feng got up and left.

The patient also suffered from being dumb. He said earlier that he had a history of eating fishbone stuck in his throat, and I am afraid it would have been resolved long ago.

This is why, the doctor must ask the detailed reason, and the reason why the patient should never hide the medical history from the doctor.

However, as long as there is no foreign body sensation about fishbone, most people think it's fine and won't mention it specifically.

However, in fact, the fishbone that enters the throat will pierce the trachea and flow into the bronchi and other parts, which is very dangerous.

Qin Feng also posted this case on the intranet. This is a typical case of consultation, and insufficient consultation will also lead to problems.

As soon as he returned to the emergency room, when passing by the ward, Qin Feng heard the doctor yelling.

"I told you not to get up, but you insisted on getting up, that's all."

"Heart stop, get your adrenaline ready!"

Qin Feng heard the voice of Wang Jun, deputy director of the emergency department. It was obvious that Wang Jun was very excited now and was extremely angry.

Then some doctors and nurses quickly came in and out of the ward. Qin Feng walked out curiously, wanting to see what happened.

(End of this chapter)