Auto chess in the operating room

Chapter 304 Berry syndrome with an incidence rate of only 0.046%

Tang Lou looked at the patient through the camera, and directly issued a diagnosis:

[Patient: Ma Wenxuan, male, 3 years old

Symptoms: cyanosis, dyspnea, heart murmur, acute respiratory distress syndrome, and heart failure. Physical examination may reveal tachycardia, tachypnea, hypotension in both lower extremities, cyanosis of the lips, heart murmur, and decreased oxygen saturation.

Diagnosis: Berry syndrome.

Berry syndrome is a rare combined cardiac malformation that includes the following 4 characteristic findings: aortopulmonary window, abnormal origin of the right pulmonary artery from the aorta, hypoplastic aortic arch (coarctated or severed), and an intact ventricular septum.

In 1982, the disease was first described by Berry et al. He pointed out that the incidence rate of this disease in congenital heart disease was 0.046%. So far, the total number of reported cases does not exceed 60 cases.
If diagnosis is delayed, Berry syndrome is fatal, and surgical treatment is the only option that provides the best prognosis.
Special reminder: It is recommended to use the i E33 ultrasonic diagnostic instrument for transthoracic echocardiography. All CT images were acquired by 64-slice multi-slice spiral CT (GE Discovery CT750 HD Systems, USA)]

After reading it, Tang Lou was also shocked. After all, the incidence rate of 0.046% is too rare. The total number of reported cases in the world has never exceeded 60. The two chief physicians of Zijingang Hospital can't find it. Not surprising anymore.

It can only be said that sometimes diagnosis requires a little bit of luck in addition to rich experience.

[Ding, new task, help Ma Shuya's little nephew come up with a diagnosis plan and treat the symptoms as soon as possible.Mission reward: 3 gold coins, refresh card library once]

After knowing the truth, Tang Lou certainly needed some foreshadowing to infer, and soon he came up with a plan.

Tang Lou seemed to have one or the other, but he began to ask carefully everywhere. At the same time, he also wanted to talk to Deputy Director Qian about the evidence of Berry Syndrome, but the information was too partial, and Deputy Director Qian did not go to Thinking about that, there was no response.

The so-called playing the piano against the bull!

Director Huang frowned dissatisfied with Tang Lou's confused question and answer. Does this young doctor really think he is the expert he invited?

Unexpectedly, it was really like a remote consultation, and the two big brothers were asked to cooperate.

The two directors of Zijingang Hospital accompanied a resident doctor from Hecheng City No. [-] Hospital for diagnosis. It would be too embarrassing to tell anyone.

Director Huang winked at Deputy Director Qian and told him to end this farce quickly.

After Deputy Director Qian said a few words, he stopped playing around with Tanglou.

Tang Lou found that it was unrealistic for them to find out by themselves, so they could only roughly pierce the window paper, pretending to have a flash of inspiration:
"Deputy Director Qian, have you tested the patient's hemodynamic signs before, can you show me?"

Originally, Deputy Director Qian wanted to refuse, but when he saw Ma Shuya's pleading eyes, he nodded and asked the bedside doctor to provide it.

Ma Shuya held up her mobile phone and quickly scanned the information page by page. Naturally, she felt the impatience of the two directors, and turned her head apologetically: "Both directors, why don't you go to work first, Tang and I The doctor will look again."

Just as Director Huang and Deputy Director Qian were about to leave, Tang Lou's voice came from the phone, seeming very excited: "Stop, I really want to find out the possible cause of the patient."

"Really!" Ma Shuya quickly turned the phone over and almost dropped it. She patted her chest and stabilized it before grabbing it again. She looked at Tanglou and saw Tanglou's expression. Somewhat weird, he coughed lightly and then said, "Looking at these data, it is obvious that the blood flow in the patient's pulmonary artery has increased significantly, and different levels of left-to-right shunting can be detected. I have a guess, but I have to look at it again Parasternal left ventricular long-axis view of the lower patient, and parasternal aorta short-axis incision."

Regarding Tang Lou's observation and new requirements, Director Huang and Deputy Director Qian were confused, but after thinking about it, they still met Tang Lou's requirements, and let him hit the south wall before giving up.

In fact, they have seen these images and materials several times. Before that, Deputy Director Qian's congenital emphysema was inferred from the patient's pulmonary artery blood flow.

Therefore, in their view, Tanglou is just picking up their wisdom and cannot draw any fresh conclusions.

Soon, according to the request of Tanglou, the little doctor in charge of the bed provided the information.

Ma Shuya turned the camera over again and showed Tang Lou a detailed look.

On the screen, Tang Lou nodded his head like a magic stick, and muttered in his mouth: "As expected, Dr. Ma, give the camera to the two directors, I have something to say."

"Good good."

Hearing Tang Lou's tone, Ma Shuya obviously had a big discovery, and immediately put the phone screen in front of the two directors.

Director Huang looked at the screen, and then Deputy Director Qian squeezed over with a big head, which made him feel a little uncomfortable, so he pushed.

Deputy Director Qian smiled awkwardly, shrank behind Director Huang, and cursed in his heart.What's this called? It's like watching a live broadcast of an internet celebrity. It's too shameful.

"Tell me."

After all, Director Huang still wanted to maintain the dignity of the Chief Physician, so he gave Tang Lou a chance to speak.

Tang Lou went straight to the point: "I suspect the patient is an extremely rare Berry syndrome."

"What? What syndrome?"

Deputy Director Qian, who shrank back, asked suspiciously, thinking that he had heard it wrong. After all, this symptom was too rare, so it involved his blind spot in knowledge.

On the contrary, Director Huang still had some impressions, and was a little surprised by Tang Lou's association ability, but he didn't agree: "Doctor Tang, you dare to think about it, but the incidence of Berry syndrome is so low, and the patient does not have typical symptoms, I don't think so. I don’t quite agree.”

Due to the diagnosis of Berry syndrome, a lot of symptomatic examinations need to be done, which is very time-consuming and energy-consuming. Under normal circumstances, when there are other higher possibilities, it must be the preferred solution with a high probability.

After all, Berry syndrome is too bizarre. It takes a lot of work for such a small probability of symptoms, which is not a scientific and reasonable way to investigate.

When Director Huang denied Tang Lou, Deputy Director Qian secretly took out his mobile phone and started Baidu. Then, the first few articles recommended to him by damn Baidu were all advertisements for Putian hospitals.

Deputy Director Qian saw the introduction of Berry Syndrome after forking several pages, and then became a little uneasy. Is there really such a rare disease?

Berry syndrome, a rare combined cardiac malformation, needs to have 4 characteristic manifestations if it is diagnosed:
Aortic-pulmonary window, abnormal origin of the right pulmonary artery from the aorta, hypoplastic aortic arch (coarctated or severed) and an intact ventricular septum.

That is, the typical sign of Berry syndrome, the "butterfly sign", that is, in the suprasternal fossa view, aortic separation or narrowing can be detected; in the parasternal high view, a patent ductus arteriosus can be seen; in the apical four-chamber view, a complete interventricular septum.

Of course, Tang Lou is trying to argue with reason. Although the current examination is not enough to confirm the diagnosis, there are still clues: "Through the hemodynamic signs, and the current parasternal left ventricle long-axis section, and the parasternal aorta short-axis incision, it has been There is a certain possibility, I think we can try it, and carry out screening according to Berry syndrome! I recommend using the i E33 ultrasonic diagnostic instrument, transthoracic echocardiography."

Hearing Tang Lou's resounding suggestion, Ma Shuya's heart skipped a beat, although reason told him that the probability of Tang Lou's conjecture and the other investigation directions deduced by Deputy Director Qian and Director Huang was not much different, or even lower.

However, it just made her feel a sense of anticipation for no reason.

Regarding Tang Lou's so confident suggestion, Director Huang was also in a daze. Is it really like what this kid said?

"Director Huang, Deputy Director Qian, we can't make a diagnosis anyway, why don't we investigate according to Dr. Tang's direction?"

Sensing Director Huang's slight wavering, Ma Shuya asked pertinently.

Deputy Director Qian also looked at Director Huang.

Director Huang thought about it seriously, and in the end, rationality prevailed, and he had never seen such a big storm before, and said lightly: "Whether it is diagnosed according to our suggestion or Doctor Tang's conjecture, I can only say that it is possible. Of course. , from my standpoint, it must be a routine disease with a higher probability of priority, rather than the extremely rare Berry syndrome like gambling. The final direction of the examination still needs to be decided by your family members.”

"However, according to Berry syndrome, transthoracic echocardiography is required. CT images are collected by 64 rows of multi-slice spirals. You are well aware of the time and energy required by Dr. Ma. Every day a patient is misdiagnosed is one more day." Very dangerous."

Director Huang, as an old Jianghu master, is naturally very good at Tai Chi. Moreover, if something does happen, he will completely shift the blame.

Several people looked at Ma Shuya, Ma Shuya hesitated, and then looked at the screen: "Doctor Tang, are you really sure?"

Tang Lou nodded, very seriously: "I'm sure."

"it is good!"

Ma Shuya immediately made a decision for her little nephew: "Director Huang, then follow Dr. Tang's deduction to do the investigation."

Looking at Ma Shuya, Director Huang pondered for a few seconds.

"Then follow Dr. Ma's advice."

Director Huang didn't expect Ma Shuya to choose to trust such a young Tang Lou in front of the two directors, she was a little dissatisfied, she agreed casually, and left indifferently.

Deputy Director Qian paused for a few seconds and felt that Dr. Ma was a little unclear. He shook his head and followed out, disapproving of Tanglou's inference.

Ma Shuya looked at the two departing directors and felt bad in her heart. She knew that she had offended the two directors, but she admitted it for the sake of her little nephew.

Ma Shuya sighed, but since she decided to trust Tang Lou, she could only gamble.

"Doctor Tang, I hope your guess is right."

(End of this chapter)