I can see health

Chapter 803 Both lists are correct!

"Could it be that the sonographer's skills are not good enough?" Jin Miao asked softly.

"Which hospital are you saying that the ultrasound department is not good? Our hospital or another hospital?" Lu Chen asked rhetorically.

"This..." Jin Miao paused.

This patient had congenital heart disease as a result of ultrasound examination in another hospital.

However, the inspection in this hospital did not see any abnormalities.

If you talk about the level of the problem, it can only be said that the level of the doctors in this hospital is not good.

But in the field of ultrasound, the ultrasound department of Guanghai No. [-] Hospital is ahead of the whole city, even the whole province.

"What's the patient's condition?" Lu Chen continued to ask.

Jin Miao immediately briefly described the patient's condition.

The patient is a female patient in her 60s.

Because of palpitations and shortness of breath for 2 months, he was admitted to the hospital after 1 week of aggravation.

After admission, apart from the current ultrasound examination, there were no obvious abnormalities in myocardial enzymes, blood routine, liver and kidney function, thyroid function, and coagulation function.

While talking, the two walked into the ward.

"Give me the ultrasound machine." Lu Chen said.

Jin Miao hurriedly handed over the ultrasound machine, and then said to the patients and their families in the ward: "This is Director Lu from our department. He is here to see the patients."

The patient's family members were surprised by Lu Chen's age, but they still respectfully called out "Director Lu".

Lu Chen walked to the hospital bed and said softly, "Grandma, I'll give you another ultrasound, don't be too nervous."

"Alright, excuse me, Director."

Although the patient's complexion was not very good, he still nodded slightly.

"Turn over a little bit."

Before performing echocardiography, the patient needs to lie on the left side at 45 degrees, which helps to reduce the influence of lung gas on the ultrasound image.

For Lu Chen's ultrasound technology, Jin Miao is still very convinced.

Many previous diagnoses were based on the fact that Lu Chen's hand is not weaker than that of a professional sonographer.

……

After half an hour.

Lu Chen took back the ultrasound equipment.

"Director, how are you?" Jin Miao said hastily.

"Everything is normal." Lu Chen said lightly.

"Ah? No congenital heart disease?" Jin Miao was taken aback.

"No." Lu Chen shook his head, "My results are similar to those of the patients in our hospital."

"Then there must be something wrong with the ultrasound results of the outer hospital!" Jin Miao said decisively.

Even though the ultrasound results of Lu Chen and this hospital are the same, the only explanation now is that the test results of the other hospital are wrong!
Lu Chen frowned, and did not express his thoughts easily.

"Go back to the doctor's office first."

Lu Chen took the ultrasound equipment and returned to the doctor's office.

Clinically, any abnormal performance may be a manifestation of certain symptoms.

Jin Miao and Gu Xinyue were all sitting in front of the computer, and Lu Chen was sitting in the middle of them.

"For the patient just now, what disease are you mainly considering?"

As the doctor in charge of the bed, Jin Miao took the lead in saying: "The patient was admitted to the hospital with chest tightness. The physical examination found that the jugular vein was full, and a small amount of fine moist rales could be heard in both lungs. Combined with the patient's laboratory examination, it is currently considered to be mainly heart failure. As for the cause of heart failure, coronary heart disease cannot be ruled out for the time being. Now after three days of treatment, the patient's condition has improved a lot."

Lu Chen nodded, then looked at Gu Xinyue, "What do you think?"

Gu Xinyue didn't reply immediately, she glanced at the patient's test report, and then said slowly: "First of all, I think what Dr. Jin said makes sense, but I noticed this..."

Gu Xinyue picked out a test sheet.

Jin Miao picked it up and took a look, then said, "The D-dimer is 6.11ug/ml, do you suspect pulmonary embolism?"

Gu Xinyue taught by correspondence, "Elevated D-dimer, fast heart rate, and symptoms of chest tightness, and if you look at the electrocardiogram, clockwise transposition, and changes in lead III, you must suspect the possibility of pulmonary embolism."

"But for patients with heart failure, some people's D-dimer will also increase!" Jin Miao said.

"I just raised a possibility that needs to be ruled out." Gu Xinyue did not deny it.

Jin Miao nodded, and suddenly looked at Lu Chen, "Director Lu, what you asked just now has something to do with the patient's abnormal echocardiogram results?"

The main contradiction of the patient at present is the inconsistency of the echocardiography.

"Of course it does!"

Lu Chen's words stunned Jin Miao and Gu Xinyue.

"What's the matter?" Jin Miao frowned.

He thought for a long time, but still couldn't figure out the connection between the two.

Gu Xinyue also looked at Lu Chen suspiciously.

Lu Chen smiled slightly, "Do you think there is a possibility that the results of these two ultrasound examination sheets are both normal?!"

"Are...all correct?" Jin Miao couldn't believe it.

In less than a few days, the congenital heart disease disappeared?Cured?
Upon hearing this, Gu Xinyue opened the patient's ultrasound sheet and continued to read it.

He knew Lu Chen very well, and it was absolutely impossible for him to say this without aiming at the target.

"To put it simply, the first ultrasound report in the other hospital was done when the condition was serious." Lu Chen said slowly, "The second ultrasound report in this hospital is after treatment and the condition has been relieved. .”

"However, in less than a week, the patient has not undergone interventional surgery at all. Can congenital heart disease be cured?"

Seeing this, Jin Miao immediately raised his own doubts.

If the patient had a congenital heart disease closure surgery, that would be explainable.

But during this period, the patient did not undergo any surgery at all!
Before Lu Chen could explain, Gu Xinyue was born suddenly.

"I know!" Gu Xinyue's eyes showed a trace of surprise, "What Director Lu means, the patient has pulmonary embolism?!"

Hearing this, Lu Chen smiled and nodded to Gu Xinyue.

Jin Miao was even a little confused, didn't he just keep talking about congenital heart disease?
Why all of a sudden, talk about pulmonary embolism?

Seeing Jin Miao's puzzled face, Gu Xinyue immediately explained excitedly: "The first inspection sheet from the outer hospital, the image of the inspection is correct. This patient has a large number of right-to-left shunts in the heart, but the real reason is not congenital. Atrial septal defect of heart disease, but patent foramen ovale!"

"What do you mean?" Jin Miao was still confused.

Gu Xinyue continued: "To put it simply, the first ultrasound report actually did not suggest congenital heart disease. The most intuitive result was a right-to-left shunt in the heart, and a sharp increase in right heart pressure."

"Yeah." Jin Miao looked at the ultrasound results again.

Gu Xinyue said: "However, right-to-left shunt, not only the atrial septal defect type of congenital heart disease, but also patent foramen ovale!"

From an anatomical point of view, the patent foramen ovale is consistent with the central type of atrial septal defect, and echocardiography sometimes cannot completely distinguish the two!
"I see!" Having said that, Jin Miao finally opened his eyes and said excitedly: "The patient's foramen ovale is not closed, and he usually does not have any symptoms, but when the pulmonary embolism occurs, the pressure on the right heart increases sharply, and it will Causes a right-to-left shunt, which looks like a congenital heart disease, but is actually just a patent foramen ovale!"

"After a few days of treatment, the patient's pulmonary embolism gradually improved, the pulmonary hypertension disappeared, the pressure of the right heart decreased, and the atrial shunt also disappeared. Therefore, the echocardiography became normal!"

From congenital heart disease, to patent foramen ovale, to pulmonary embolism, and the abnormality of two ultrasound results.

Jin Miao became more and more excited by the interlocking thinking of clinical diagnosis and treatment.

This feeling of epiphany is hard for outsiders to feel.

(End of this chapter)