It looks a little blurry here. It looks like a real image, "Zhao Yunlong said." Boss Zheng, do you think it's a tumor? "
Zhao Yunlong was stunned for a moment. It was a very typical imaging information. He had only asked Boss Zheng to take a look for some careful thoughts. Why did it not seem to be the case from what he said?
It showed a large mass-like consolidation in the lingual lobe of the lung. It was related to the collapse of the lung lobe, and the lymph nodes under the carina of the left hilum and trachea were swollen. Zhao Yunlong took a closer look at the radiographic films to rule out what he had missed. After confirming it again, he nodded.
Hearing the word "tumor", the young man next to him felt a little weak and panicked.
"It's not a tumor," Zheng Ren said. "Be careful … It's a pity that there's only one X-ray. The density of the image here is different from that of a tumor. It's higher. Do you think it's a little similar to bone? "
Zhao Yunlong looked at the white image and tried his best to find the place where the density was different.
But he could not do it.
Normally speaking, if he encountered a similar patient in the outpatient department, Zhao Yunlong would let the patient do a lung CT scan. Then, if he found the problem, he would do a 64-slice CT scan with 3D-image reconstruction.
After gradually increasing the intensity of the examination, the problem would be discovered.
Boss Zheng's ability to read the radiographic films was countless times stronger than Zhao Yunlong's, especially his ability to reconstruct it. Zheng Ren could see the problem from the white image, but Zhao Yunlong could not.
"Doctor …"
"Call me Professor Zheng," Zhao Yunlong said a little sternly.
"Oh, oh, Professor Zheng, what are you talking about? My dad's not lung cancer, right? "the patient's son asked.
Zheng Ren shook his head and said, "It doesn't look like lung cancer. Combined with the medical history you said, I think it's airway stones."
"Stones? Isn't there a stone in the kidney? "the patient's son asked in a daze.
He only knew about kidney stones. If he tried to recall carefully, he seemed to be able to remember gallstones. However, airway stones were too unfamiliar to him. He could not understand what Zheng Ren was saying at all.
"Erm, it's like this." Zheng Ren used the pen in his hand to point at the radiographic film viewer. "To be precise, it should be called bronchial stones. They usually happen on the right side. But your old man's is more special. It's on the left side. Bronchial lithiasis, also known as lithotripsy, refers to the presence of calcification or ossification in the bronchial lumen or bronchial wall. It is a relatively rare clinical disease. "
"Lithotripsy? Coughing out stones? "The patient's son found it hard to imagine that scene.
"Yes." Zheng Ren nodded and said, "Many people don't even pay attention to the stones they cough up, nor do they think of the stones growing in the trachea. Therefore, this kind of disease is generally discovered through clinical examinations."
"Uh … there's a stone in my lungs. Can you understand it that way, Prof … Professor Zheng," the patient's son asked.
"You could say that," Zheng Ren said.
"Then where did it come from? The patient's son still refused to believe it. He used his own logic to determine that it was impossible. If it weren't for the fact that Zhao Yunlong was by his side, showing respect and trust for this young Professor Zheng, he would have definitely become famous a long time ago.
"There are several sources. First, the core of the calculus is formed by the attraction of foreign bodies in the airway or by the secretion of infection. The surrounding calcium salt deposits gradually form the calculus. To put it simply, it's caused by a foreign object entering the respiratory tract. A typical example would be the inhalation tract of a small flying insect. "
"The second is hilar lymph node calcification or pulmonary calcification that erodes the bronchus and enters the bronchial lumen. These are the most common clinical cases. But looking at the image, it shouldn't be like this. "
"The third more common possibility is that the cricoid cartilage of the trachea falls off …"
"Professor Zheng, are you saying that the bone fell off?" The patient's son thought about it with his own understanding and was terrified after thinking about it carefully.
"You can say that, but it's different from what you think." Zheng Ren pointed at a small spot on the left upper lung and said, "From the looks of it, your father should have had tuberculosis in the past."
"…" The patient's son was at a loss.
Tuberculosis was no longer like it was more than a hundred years ago. Many people did not even notice it before it healed on its own.
Even the patient himself did not know that he was actually a tuberculosis patient.
This was very common in clinical practice, so Zheng Ren did not think much of it.
He briefly explained to the patient's family how the tuberculosis bacteria acted on the trachea cartilage, causing the cartilage to fall off and cause bronchial stones.
Actually, Zheng Ren was mainly telling Zhao Yunlong.
"I won't tell you in detail if it's too specific," Zheng Ren said. "Go home and bring your father to the nearest big hospital."
After hesitating for a moment, Zheng Ren continued, "At least it's a city-level tertiary Grade A hospital. It's better to go to the Provincial Capital. This disease is very rare in city-level tertiary Grade A hospitals."
The patient's son wanted to ask something again, but he was bumped into by Zhao Yunlong and swallowed the rest of his words.
"Boss Zheng, I'll arrange that. What kind of examination do you want to do? Bronchoscopy to remove the stones? "Zhao Yunlong asked.
"Yes, find a more experienced doctor to take it. If the bronchial stones are not handled properly, the complications are still very serious, "Zheng Ren said." Don't worry. I think it's not lung cancer. "
Zheng Ren's last sentence made the patient's son feel relieved. He happily took the radiographic films and thanked Zhao Yunlong before turning around and leaving.
Zhao Yunlong wanted to stop him. Boss Zheng, who was watching the radiographic films, did not even say thank you. How could he be so rude?
However, his reaction was a little slow. The patient's son had already left happily.
"Professor Zhao, you thought it was lung cancer at first, right?" Zheng Ren asked with a smile.
Zhao Yunlong had long been discouraged when he faced Boss Zheng. He could not be competitive at all. He told the truth. "Yes, I saw that there was a high-density shadow in the inflammation shadow of the left lower lung. The edges were irregular and there were burrs. I thought it was lung cancer."
"Then why did you look for me to take a look?" Zheng Ren sat back in his seat, picked up the red string, and began to weave the red string.
"Because there was hemoptysis before, blood stasis, and blood clots may cause blockages in the bronchus, forming a high-density shadow that covers up the bronchial stone shadow. It's very easy to misdiagnose it as lung cancer. "I'm not sure. I originally wanted my classmate to do a CT scan, but didn't I see you now?" Zhao Yunlong said with a smile.
Zheng Ren weaved the red string and did not think too much about it. Zhao Yunlong always hid half of his words. Did he see him? That should not be the case. He came back from the outpatient clinic with the radiographic films. Normally speaking, he was coming for him.
Perhaps he was not sure what was going on, so he looked for him to take a look. However, thinking about these thoughts was very tiring. Zheng Ren did not want to think about it too much and continued to weave the red string.
"Oh, right." Zheng Ren thought of something and said to Zhao Yunlong, "Because it's been a long time, there's granulation tissue hyperplasia. It's easy to be misdiagnosed as a new organism under the tracheoscope. At this time, a biopsy is needed first to exclude the tumor before stone removal treatment. "
"Didn't you diagnose it?" Zhao Yunlong asked in confusion.
"I just took a look and had some thoughts. I can't say that it's a diagnosis. The only thing that can be diagnosed is pathology. Looking at the radiographic films is just a guess, "Zheng Ren said.
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