Section 110

Seeing Zhang Yi coming over, he wanted to pull Zhang Yi to play together:

"Come on! This game called Yuanshen is so fun!"

Zhang Yi took a look and said with a little disdain:

"You just started? I've played to Inazuma."

Chen Fang was surprised: "Why don't I see you playing normally?"

Zhang Yi shook his head:

"I play after get off work, not during work."

Suddenly, Zhang Yi's phone rang.

When he opened it, it was a WeChat message from the classmates group.

It was Li Xiuhui who sent a message and tagged everyone.

Li Xiuhui: " x-on:Everyone, please help me look at this case!"

Li Xiuhui: "I am so miserable! Finally, my teacher gave me a chance to see a patient by myself, but a particularly difficult patient came!"

Li Xiuhui: "The patient is a 28-year-old male, without fever or night sweats, but with cough, a small amount of white sputum, no chest pain, and hemoptysis.

He has no history of other diseases, and has never worked on a construction site or in a heavy metal place.

He is just an ordinary small boss who runs a bakery and sells cakes and snacks.

So I first denied pneumoconiosis and considered it ordinary pneumonia."

Li Xiuhui: "Let me show you his lung CT scan!"

Swish.

Li Xiuhui sent out six or seven CT scans of the patient's lungs at once.

Zhang Yi thought.

I just won the auxiliary examination and diagnosis knowledge yesterday!

Won't it come in handy today?

So Zhang Yi clicked on the picture to see if he could see anything.

First of all, at first glance, you can see that the bilateral hilum of this person is enlarged, and there are micro-particle nodules.

The distribution is scattered and spotty.

This looks like an inflammatory infection.

But here comes the problem.

Li Xiuhui said that she met a very difficult patient.

That means this is not an ordinary pneumonia patient.

Zhang Yi carefully watched the pictures again and again.

And Li Xiuhui's main complaint.

After thinking for a while.

Zhang Yi suspected two results.

First, pulmonary sarcoidosis.

Second, inhalation allergic alveolitis.

In the group, seeing these pictures posted by Li Xiuhui, everyone began to discuss actively.

Mao Jun: "Isn't it pneumonia? What's so complicated?"

Liu Yuanyuan: "I also feel it's pneumonia. How to use levofloxacin?"

Liu Zifei: "I don't think it's that simple. Some CT scans of primary lung cancer are very similar to this. Xiuhui, why don't you consider doing a pathological biopsy?"

Gong Shiming: "It's not that serious. How can this shadow and nodule look like lung cancer? If general antibiotic treatment is ineffective, you can check for mycoplasma infection. I think it should be mycoplasma."

Everyone discussed enthusiastically.

Everyone showed what they learned during their internship this year.

Li Xiuhui suddenly said, "I... have already prescribed him levofloxacin plus amoxicillin clavulanic acid. He has been on infusion for two days and there is no improvement.

And I checked for mycoplasma, and it was not found. Otherwise, why would I treat it as pneumonia...

Oh, I am so confused. Our teacher said at the beginning that I didn't look carefully.

But now he is a little suspicious whether it is primary lung cancer...

I am discussing with his family whether to do a puncture biopsy to check it out."

After Li Xiuhui said this, all the students in the group shut up.

It is neither pneumonia, nor lung cancer, nor mycoplasma infection.

That is beyond their experience.

At this time, Zhang Yi knew.

It was his turn.

Zhang Yi directly took a screenshot of the CT film sent by Li Xiuhui, marked a few key points, and sent it to the group.

Chapter 87 Zhang Yi's analysis is awesome and on point

After posting the picture to the group, Zhang Yi began to explain:

"Let me share my personal opinion."

"First of all, we can't just look at the appearance when looking at the film, we have to combine it with the patient's actual situation.

If you look closely, you can find that the patient's lungs are swollen on both sides, which proves that he actually has inflammation.

But they didn't find out what kind of bacterial infection it was, and even mycoplasma or chlamydia were not detected.

This means that the patient's pneumonia is not caused by fungal infection, so antibiotics cannot be used to treat it.

This also proves why you, Li Xiuhui, have used antibiotics for treatment but it has no effect.

You can zoom in on the first picture I posted. The blood vessel I marked is the pulmonary artery, and there is a parallel bronchus behind it. The distal micronodules are distributed between the branches of the pulmonary artery, indicating that they are located in the lymph nodes.

This kind of microparticle nodules distributed in the lymph nodes are the most Common in pneumoconiosis, pulmonary sarcoidosis and carcinomatous lymphangitis.

But the first pneumoconiosis can be basically ruled out.

The second pulmonary sarcoidosis is very likely.

Also, the most important point I think everyone has overlooked.

Li Xiuhui, since you can consider pneumoconiosis, why don't you think about the patient's current working environment?

The patient is the owner of a bakery, making bread and cakes every day, and he must be in contact with flour frequently.

Factory workers can get lung diseases if they are exposed to heavy metals or dust for a long time.

Then flour will not?

Combined with your main complaint, the patient has no coughing up blood and no chest tightness, but has white sputum.

So my first diagnosis is inhalation allergic alveolitis, followed by pulmonary sarcoidosis.

Of course, to be more conservative, lung cancer cannot be ruled out.

My personal opinion is that I am more inclined to the first two symptoms, you can focus on checking them. "

Zhang Yi finished speaking.

The entire group of students immediately fell silent! !

Hiss!

I knock!

What's wrong with Zhang Yi? !

Why does his analysis seem to make sense? ?

Like a teacher!

Li Xiuhui was also confused.

From the moment she admitted this patient, the first thing she considered was ordinary pneumonia.

Because the patient is very young, the chance of getting cancer is very small.

But after a few days of antibiotics, there was no effect at all.

The CT scan taken again was still a white shadow.

She was scolded by the teacher for this.

But now...

Zhang Yi's words really woke her up!