"It looks a bit blurry here, like a solid image." Zhao Wenhua said, "Boss Zheng, do you think it's a tumor?"
Zhao Wenhua was startled for a moment. It was very typical of imaging data. He only asked Boss Zheng to take a look at it for some small reasons. Why didn't it sound like he meant something different
It shows a large mass-like consolidation in the lingual lobe of the lung, which is related to the collapse of the lung lobe, and the lymph nodes under the left hilar and tracheal carina are enlarged. Zhao Wenhua took another careful look at the film to rule out what he had missed, and then nodded after making sure again.
When he heard the word "tumor", the young man next to him became a little weak in his legs and panicked.
"It's not a tumor." Zheng Ren said, "Careful... It's a pity that there is only one X-ray. The image density here is different from that of the tumor, it is higher. Do you think it looks a bit like bone?"
Zhao Wenhua looked at the image of white flowers and tried hard to find places with different densities.
But he couldn't do it.
Normally, if he encounters similar patients in the outpatient clinic, Zhao Wenhua should ask the patient to do a plain lung CT scan, then find the problem, and then do a 64-slice CT three-dimensional reconstruction.
Increasing the intensity of the inspection will reveal the problem.
Boss Zheng's film reading ability is countless times better than Zhao Wenhua's, especially his reconstruction ability is vividly demonstrated here. Zheng Ren could see the problem from Bai Huahua's image, but Zhao Wenhua could not.
"Doctor..."
"Call Professor Zheng." Zhao Wenhua said slightly sternly.
"Oh, oh, Professor Zheng, what do you mean? My dad doesn't have lung cancer, right?" the patient's son asked.
Zheng Ren shook his head and said, "It doesn't look like lung cancer. Based on the medical history you mentioned, I think it's airway stones."
"Stones? Aren't there stones in the kidney?" the patient's son asked in a daze.
The only thing he knew about was kidney stones, and if he recalled it carefully, he seemed to be able to recall gallstones. But airway stones were too unfamiliar to him, and he couldn't understand what Zheng Ren was saying.
"Emm, that's it." Zheng Ren pointed at the reader with the pen in his hand, "To be precise, it should be called bronchial stones, which tend to occur on the right side. But your old man's one is special, it's on the left side. Broncholithiasis, also known as litholithiasis, refers to the presence of calcification or ossification components in the bronchial lumen or bronchial wall. It is a relatively rare clinical disease."
"Liliths? Coughing out stones?" The patient's son found it difficult to imagine that scene.
"Yes." Zheng Ren nodded and said, "Many people don't pay attention to the stones they cough up, nor do they think about the stones growing in the trachea, so this disease is generally discovered through clinical examination. .”
"Uh... I have stones in my lungs. Can you understand it that way, Professor Zheng?" the patient's son asked.
"You can say that." Zheng Ren said.
"How did that come about? Are stones growing like this?" The patient's son still refused to believe it. He used his own logic to judge that this was impossible. If Zhao Wenhua hadn't been by his side, showing respect and trust in the young Professor Zheng, he would have become angry.
"There are several sources. The first is that foreign bodies in the airway are attracted or infected secretions form the core of the stones, and calcium salts are deposited on the periphery to gradually form stones. Simply put, it is caused by the entry of some kind of foreign body into the respiratory tract. It is more typical. It’s that little flying insect that gets sucked into the airway.”
"The second is hilar lymph node calcification or intrapulmonary calcification lesions that erode the bronchus and enter the bronchial lumen. This is the most common clinical condition. But when I look at the images, that shouldn't be the case."
"The third more common possibility is that the cricoid cartilage of the trachea has fallen off..."
"Professor Zheng, are you saying that the bones have fallen off?" The patient's son thought about it with his own understanding, and he was horrified to think about it.
"You can say that, but it's different from what you think." Zheng Ren clicked a small spot on his upper left lung and said, "Looking from here, your father should have had tuberculosis in the past."
"..." The patient's son looked confused.
Nowadays, tuberculosis is no longer what it was a hundred years ago. Many people don’t even realize they have it and then recover on their own.
Even the patient himself did not know that he was a tuberculosis patient.
This is very common in clinical practice, and Zheng Ren didn't think it was anything.
He briefly explained to the patient's family how the tuberculosis bacteria acts on the tracheal cartilage, causing the cartilage to fall off and causing bronchial stones.
In fact, Zheng Ren mainly told Zhao Wenhua.
"It's too specific so I won't tell you the details." Zheng Ren said, "Go home and take your father to the nearest larger hospital."
After hesitating for a moment, Zheng Ren continued: "At least it's a municipal-level tertiary hospital. It's better to go to the provincial capital. This disease is very rare in municipal-level tertiary hospitals."
The patient's son wanted to ask something else, but Zhao Wenhua knocked him and swallowed the rest of his words.
"Boss Zheng, I'll make the arrangements there. What kind of examination do you want? Bronchoscopy to remove stones?" Zhao Wenhua asked.
"Well, find an experienced doctor to remove it. If the bronchial stone is not handled properly, the complications will be serious." Zheng Ren said, "Don't worry, I don't think it is lung cancer."
Zheng Ren's last words reassured the patient's son. He happily took the film and thanked Zhao Wenhua, then turned and left.
Zhao Wenhua wanted to stop him, but Boss Zheng didn't even say thank you for watching the movie. How could he be so rude
But his reaction was a little slow, and the patient's son had already left happily.
"Professor Zhao, you thought it was lung cancer at first." Zheng Ren asked with a smile.
Zhao Wenhua was already discouraged when he faced Boss Zheng. He couldn't bring himself to be competitive. He told the truth, "Well, I see that there are high-density shadows in the inflammation shadow of the left lower lung, with irregular edges and burrs. I think It’s lung cancer.”
"Then why are you looking for me to take a look?" Zheng Ren sat back on his seat, picked up the red thread and began to weave the red rope.
"Because I had hemoptysis and blood stasis before, the blood clot may block the bronchus, form a higher density shadow, cover up the bronchial stone shadow, and it is easy to be misdiagnosed as lung cancer. I was not sure, and originally wanted my classmate to do a CT scan. , But didn’t I see you?” Zhao Wenhua said with a smile.
Zheng Ren braided the red rope without thinking too deeply about it. Zhao Wenhua always talks half-hidden and half-hidden. Have you seen yourself? This shouldn't be the case. He came back from the outpatient clinic with the film in hand. Normally, he came here for himself.
Maybe he wasn't sure what was going on, so he took a look at himself. But it was tiring to think about these details. Zheng Ren didn't want to think about it anymore and continued to weave the red rope.
"Oh, by the way." Zheng Ren remembered something and said to Zhao Wenhua: "Because it takes a long time and there is granulation tissue hyperplasia, it is easy to be misdiagnosed as new organisms under the bronchoscopy. At this time, a biopsy needs to be performed first to rule out the tumor. Stone removal treatment”
"Aren't you diagnosed?" Zhao Wenhua asked with some confusion.
"I just took a look and had some ideas. I can't say it's a diagnosis. The only thing that can be diagnosed is pathology. Looking at the film is just guessing." Zheng Ren said.