On the film, the patient did not have a spleen.
What remains in place can be vaguely seen as scar tissue.
"Well, I guess he had a splenectomy." Zheng Ren then asked, "Who are you as a patient?"
"It's my lover." The middle-aged man answered cautiously.
"How many years ago was the splenectomy performed?" Zheng Ren asked.
"Twenty-two years ago, I had a car accident and later had a splenectomy." The man replied immediately.
When doctors generally look at the film, the first question they ask is about splenectomy, not a mirror image, nothing special.
Zheng Ren continued to watch with his chin raised, while the professor stood behind him, also reading the film attentively.
It’s been a long time since I watched a movie with my boss. This feeling is really great.
A few minutes later, the professor said: "Boss, this liver cancer is a bit strange. Why do I think it's not the case?"
"Well, it's a little strange, but it's hard to tell if it's liver cancer." Zheng Ren held his chin, looked at the film, and said, "I highly suspect it is an ectopic spleen implantation, not liver cancer."
"What?" Professor Rudolf Wagner was surprised, "Boss, how did you see it? Is this one a bit bald and reversed?"
As he spoke, the professor clicked on a location on the film with an abnormal signal.
"That's not entirely true. There's just some signal abnormality there. Fuguier, did you notice that the patient has undergone interventional embolization once?"
"I noticed it." When Professor Rudolf Wagner heard Zheng Ren talking about embolism, he seemed to remember something and stared at certain frames of the film carefully.
Zheng Ren did not continue to explain. As for the professor's reading skills, what he said here was enough.
The middle-aged man was confused.
Ordinarily, shouldn’t liars make the illness as serious as possible? But how could this young "doctor" say it wasn't liver cancer
What kind of ectopic planting
Has it been transferred
With his mind filled with doubts, his ears pricked up, wanting to listen to the conversation between Zheng Ren and Professor Rudolf Wagner.
But then the two of them fell silent, without saying a word, and began to "face each other" in front of the film.
A few minutes later, the professor made a fist with his right hand and hit the palm of his left hand with a "pop" sound. The professor and Su Yun learned this movement very well.
"Boss, I figured it out! It is indeed an ectopic spleen transplant!" Professor Rudolf Wagner said happily.
"Well, the diagnosis is relatively clear. Especially after an interventional embolization treatment, it has been basically confirmed." Zheng Rendao.
After saying that, he took off the film, put it in the film bag, and said: "You go to see Teacher Yang. I will write the diagnosis on paper after a while. For this disease, Teacher Yang will perform an excision surgery, and the postoperative pathology Diagnosis is enough."
As he spoke, Zheng Ren found a piece of discarded A4 paper. He scratched a few lines on the front to indicate that it was invalid, and then wrote his diagnosis and surgical recommendations on the back.
The patient's family members were stunned.
He had already sketched out many possible things Zheng Ren might say in his mind, and he had made contingency plans for each one.
He knew what to do if he was a liar.
However, this young "liar" actually sent himself back to the general surgery department.
Could it be that I guessed wrong
The middle-aged man held the paper in his hand, looked at the words on it carefully, and became confused.
"Go ahead. I heard from Teacher Yang that your wife has been suffering from upper abdominal pain all year round. It was caused by the spleen transplantation and the backlog of the liver. It's nothing serious. Just remove it and it will be fine." Zheng Ren said, taking out his mobile phone.
He first left a note on Professor Yang's cell phone and then dialed out.
"Teacher Yang, I've finished watching the patient's films."
"Well… "
"Okay, okay. Brother Yang, the film is considering ectopic spleen transplantation, not liver cancer."
"Yes, yes, your judgment is correct. If there is a bed, admit it to the hospital and do a resection. Pathology... you can see it is spleen tissue during the incision."
"Oh, okay, the patient's family is here with me. I'll take them up..."
"Okay, then I'll wait for you."
After speaking, Zheng Ren hung up the phone.
"Teacher Yang... Brother Yang said he would come down in a while and wait a moment so as not to miss him." Zheng Ren said to the patient's family.
The patient's family members were confused, and the development of the matter had completely deviated from his expectations.
Soon, Professor Yang hurried to the interventional department wearing an isolation gown and a sterile cap.
"Boss Zheng, I don't think it's liver cancer." Professor Yang said hurriedly after entering the door.
It seemed that he had just stepped down from the stage and hadn't even had time to change his clothes. It might even be possible that he took the time to run down during the interval between surgeries.
"The probability is 90% that it is an ectopic spleen transplant." Zheng Ren nodded.
Zheng Ren cannot and does not dare to guarantee this kind of thing 100%. If it is malignant if frozen during surgery, there is no way to explain it.
Without a pathological gold standard, Zheng Ren would have doubts about the diagnosis of big pig's trotters.
"Boss Zheng, your level is really high." Professor Yang praised: "Tell me how you can tell."
Zheng Ren felt a little strange. An autologous liver transplant, but Professor Yang was like this
However, when he saw that Professor Yang was concentrating on watching the movie, he seemed to be speaking from his heart, so he smiled without thinking too much.
"You are not involved in interventional medicine, so you don't know much about interventional images." Zheng Rendao: "The patient underwent interventional embolization. Look here. From the images of lipiodol deposition after embolization, there are only embolized necrotic lesions, while typical The liver cancer lesions were not shown on the images."
"It is rare for liver cancer to show this kind of image. In addition, the patient's medical history includes intermittent abdominal pain for many years, and a history of splenectomy 22 years ago, so I judge that the possibility of ectopic spleen implantation is relatively high."
Professor Yang watched the film. Zheng Ren's words solved several of his questions, but the reasons were not very sufficient.
Zheng Ren's words can deny liver cancer with a high probability, but spleen transplantation cannot be denied.
"Boss Zheng, if you want to transplant your spleen..."
"The preoperative 64-slice CT scan showed uniform enhancement in the arterial phase and slight enhancement in the venous phase. Angiography showed that the branches of the hepatic artery supply this round mass with rich blood supply. At this time, liver cancer was suspected. There's no mistake." Zheng Ren said, picking out another film from the film bag.
"On postoperative review, the arterial phase enhancement of MRI was not obvious, but the metastatic lesions on the abdominal wall showed the opposite characteristics." Zheng Rendao: "Because the blood vessels of the abdominal wall lesions are relatively thin, there is no embolization treatment, which is inconsistent with the intervention of splenomegaly. The images after embolization are particularly similar.”
Interventional embolization therapy for splenomegaly and cirrhosis can effectively increase the values of white blood cells and platelets.
Although Zheng Ren has never done any interventional surgery, he is close to the peak of interventional surgery, and he knows this kind of "minor surgery" well.
"So, I am most likely sure that the local doctor performed a splenic embolization surgery." Zheng Ren said with a smile.