Pulmonary embolism, also called pulmonary infarction.
It refers to a clinical condition in which endogenous or exogenous emboli block the pulmonary artery or its branches, causing pulmonary circulation disorders.
The main source is thrombus, and others include amniotic fluid embolism, fat embolism, air embolism, foreign body embolism, etc.
For example, amniotic fluid embolism is a serious complication after caesarean section. Thrombolytic treatment is not yet available, and ten years ago, it was almost an untreatable disease.
One of the most feared complications of orthopedic surgery is fat embolism.
After patients develop pulmonary embolism, they will experience severe pain in the chest and back and difficulty breathing.
However, patients in the early stage generally feel that it will be over if they endure it, which delays the best treatment time.
But even after arriving at the hospital, when the earliest symptoms are atypical, the embolism site is not as typical as this patient's, and it is easy to be missed.
Judging from the film, there is no doubt that the thrombus originating from the pulmonary valve blocked the main pulmonary artery.
It can't be removed even by thrombectomy, grinding... The blood vessel wall is too thin, completely different from the coronary artery. Coupled with the fact that it originates from the pulmonary valve, emboli on the valve cannot be treated.
Grinding surgery is not possible.
Zheng Ren's first impression, like that of many 912 directors, was that patients could only be treated with thrombolysis.
But just when he was about to look away from the image, Zheng Rensheng stopped his eyes again.
For a moment, the vestibular nerves trembled violently, which was very uncomfortable.
It was like riding a roller coaster for a moment.
Sensing something was wrong with Zheng Ren, Director Wei asked, "Boss Zheng, are you a little tired after a long day of work?"
"No, there's something wrong with the film." Zheng Ren said, looking straight at the film.
"Huh?" Director Wei was confused.
The imaging was very typical, and the whole hospital consulted, and no one had any objection to the diagnosis. There are slight differences, but there are some differences in treatment.
"Wait a minute, I'll think about it again." Zheng Ren said, and then began to use his reconstruction ability.
For images of this location, three-dimensional reconstruction, MRI enhancement, and vascular CTA are all useless.
Based on the most basic imaging data, Zheng Ren used dual-energy CT reconstruction mode to re-observe the lesions originating from the pulmonary valve.
The dual-energy CT system can use X-rays of two different energies to image objects, and can accurately obtain the composition ratio of the object.
Its principle has been proposed in the 1970s.
By using two photon beams of different energies to penetrate the stage for imaging, and using the difference in the energy absorption curves of different materials, the composition of the object can be accurately calculated.
Of course, to be very close to the truth requires the doctor who reads the images to have an extremely deep understanding of the images.
And Zheng Ren is this person.
The ability to rebuild is very handy. But Zheng Ren found it a bit difficult to do dual-energy CT.
The brain is at full power, like a machine, roaring continuously. The CPU quickly processed various data, and Zheng Ren was slightly overwhelmed.
However, the dual-energy CT image was still established.
It's a bit blurry and still different from the images produced by standard machines. Even so, Zheng Ren felt that enough was enough.
The image showed another situation, completely different from the previous judgment.
The large filling defect near the pulmonary valve is not a thromboembolism!
Not a blood clot, but an echo of abnormal body tissue.
Zheng Ren looked at the dual-energy CT images that were added in his mind. After being excited for a moment, he suddenly fell silent.
Although it was not an emboli, it overturned the previous diagnosis.
But abnormal body tissue... means that there is a tumor tissue in the patient's pulmonary valve area!
No matter benign or malignant, it is a tumor tissue!
Pulmonary valve tumors are quite rare.
"Su Yun, ask Fugui'er to come up." Zheng Ren said in a deep voice.
Director Wei and Lin Ge were both stunned. What does Boss Zheng mean
After a brief, awkward silence, Zheng Ren immediately realized that he was now in the doctor's office in the ICU, and Su Yun was not with him.
"Sorry, Director Lin, Director Wei." Zheng Ren smiled sarcastically.
"Boss Zheng? What did you find?" Director Wei asked in a low voice.
In this case of pulmonary embolism caused by thrombus in the pulmonary valve, Boss Zheng also needs surgery to treat it
Because some thrombi are not fixed in their original locations, embolism in other locations is very likely to occur during surgery.
So, this is a contraindication to surgery!
Boss Zheng is preparing to attack the penalty area? impossible.
No, his name is Professor Rudolf Wagner. Does he want to use interventional surgery
No, Director Mao Chi didn't say anything.
"Director Wei, I thought it was pulmonary embolism at first." Zheng Ren said, "But after watching the film, I felt something was wrong."
"What's the problem?" Director Wei asked.
"How should I put it? Based on the subtle sense, I initially judged that the filling defect in the pulmonary valve area is body tissue."
"..." Director Wei was speechless.
This passage is a bit unfamiliar to ordinary people. But for doctors, the presence of body tissue in the pulmonary valve area means that there is a benign or malignant tumor there!
I go to... Tumor in the pulmonary valve area
Boss Zheng really dares to think about it.
But Director Wei did not refute. He had chatted with Feng Jianguo some time ago and said that Boss Zheng might not be good at laparoscopic surgery.
Then he was slapped in the face by a standard laparoscopic emergency surgery to stop bleeding and remove foreign bodies.
Boss Zheng immediately diagnosed a pulmonary valve tumor. Director Wei really wanted to criticize Boss Zheng, but he held it back.
Forget it, just listen and don't make the same joke as the laparoscopic surgery.
"Let's go and see the patient." Zheng Ren said.
Lin Ge felt that Boss Zheng was out of control at this time, like a little beast.
His mind was filled with surgery and patients.
Provide Boss Zheng with more surgical opportunities? It seems like I can't do it myself. Besides, Director Kong has already contacted the community hospital for Boss Zheng.
Others have done what they should do, and I came a little late.
So what to do
Zheng Ren took out his mobile phone and walked out of the ICU doctor's office.
"Su Yun, ICU, call Fugui'er."
"I'm busy, that's all. I'm looking for Zhao Yunlong for the pulmonary valve tumor. You can get busy."
After saying that, Zheng Ren hung up without waiting for what Su Yun said on the phone.
But he didn't continue to call.
"Boss Zheng, are you looking for someone with a big heart?" Lin Ge immediately approached and asked.
"No, Su Yun will be here soon."
"Isn't Dr. Su busy?" Lin Ge was a little confused, whether he heard wrongly.
"There are only 37 reported cases of patients with pulmonary valve tumors in the world, 35 of which were known by autopsy after death, and 2 cases were operated on, but the operation failed." Zheng Rendao: "When encountering this kind of case, he has You have to let go of all the big things.”