On the radiographic films, the patient did not have a spleen.
A scar tissue could be vaguely seen in the original position.
"Yes, he probably had a splenectomy." Zheng Ren then asked, "Who is the patient to you?"
"He's my lover," the middle-aged man answered cautiously.
"How many years ago was the splenectomy done?" Zheng Ren asked.
"Twenty-two years ago. He had a car accident and had a splenectomy," the man answered immediately.
Usually, when doctors looked at radiographic films, the first question they asked was about the splenectomy. It was not a mirror image, so there was nothing special about it.
Zheng Ren continued to look at it with his chin on his hand. The professor stood behind him, also focused on reading the radiographic films.
It had been a long time since he had watched radiographic films with his boss. This feeling was really great.
A few minutes later, the professor said, "Boss, this liver cancer is a little strange. Why do I feel that it's not?"
"Yes, it's a little strange, but it's hard to say if it's liver cancer." Zheng Ren held his chin and looked at the radiographic films. "I highly suspect that it's an ectopic splenectomy, not liver cancer."
"What?" Professor Rudolf Wagner was surprised. "Boss, how did you know? Is it because of this balding part? "
As he spoke, the professor pointed at a location with an abnormal signal on the radiographic films.
"Not entirely. There's just a little abnormal signal there. Lil Fugui, did you notice that the patient had an interventional embolization? "
"I noticed it." When Professor Rudolf Wagner heard Zheng Ren mention the embolization, he seemed to have thought of something and stared at a few frames of the radiographic films carefully.
Zheng Ren did not continue to explain. It was enough for him to say so much about the professor's level of reading radiographic films.
The middle-aged man was puzzled.
Shouldn't a liar say that the illness was as serious as possible? But why did this young 'doctor' say that it was not liver cancer?
What kind of ectopic implantation?
Was it transferred?
With his mind full of doubts, his ears perked up, wanting to hear the conversation between Zheng Ren and Professor Rudolf Wagner.
However, the two of them fell silent and did not say a word. They began to 'look at' the radiographic films.
A few minutes later, the professor clenched his right fist and hit his left palm with a 'pa' sound. The professor and Su Yun had learned this action perfectly.
"Boss, I understand now! It's indeed an ectopic splenectomy! "Professor Rudolf Wagner said happily.
"Yes, the diagnosis is relatively clear. Especially after an interventional embolization treatment, I can basically confirm it, "Zheng Ren said.
After saying that, he took off the radiographic films and put them in the bag. He said, "Go and find Teacher Yang. I'll write the diagnosis on a piece of paper later. For this disease, Teacher Yang only needs to perform a surgical resection and postoperative pathological diagnosis. That should be enough. "
As he spoke, he found a piece of discarded A4 paper and scratched a few lines on the front to indicate that it was invalid. Then, he wrote his diagnosis and surgical suggestions on the back.
The patient's family was stunned.
He had already outlined many things Zheng Ren could say in his mind, and he had made contingency plans for each of them.
If it was a swindler, he knew what to do.
However, this young 'liar' actually sent him back to the General Surgery Department.
Could it be that he had guessed wrong?
The middle-aged man held the paper in his hand and carefully looked at the words on it. He was puzzled.
"Go ahead. I heard from Mr. Yang that your wife used to have epigastric pain all year round. That's because of the spleen implantation. It's not a big deal. I'll just remove it, "Zheng Ren said as he took out his phone.
He first left a note on Professor Yang's phone and then dialed.
"Professor Yang, I've finished looking at the patient's radiographic films."
"Uh …"
"Okay, okay. Brother Yang, the radiographic films consider ectopic spleen implantation, not liver cancer. "
"Yes, yes, your judgment is right. If there's a bed, let's admit it to the hospital and do a surgical resection. Pathology … During the surgery, we can see that it's spleen tissue. "
"Oh, okay. The patient's family is with me. I'll bring them up … "
"Okay, I'll wait for you."
After saying that, Zheng Ren hung up the phone.
"Professor Yang … Brother Yang said that he'll come down in a while. Let's wait for a while in case we don't meet," Zheng Ren said to the patient's family.
The patient's family was dumbfounded. The development of the situation had completely exceeded his expectations.
Soon, Professor Yang, wearing an isolation suit and a sterile cap, rushed to the Interventional Department.
"Boss Zheng, I don't think it's liver cancer," Professor Yang said hurriedly after entering the door.
It seemed that he had just left the stage and did not even have time to change his clothes. It was even possible that he had taken the time to run down during the intermission of the surgery.
"There's a 90% chance that it's an ectopic spleen implantation." Zheng Ren nodded.
Zheng Ren could not and did not dare to guarantee this kind of thing with 100% certainty. If it was frozen during the surgery and it was malignant, there was no way to explain it.
Without the golden standard of pathology, Zheng Ren had to doubt the System's diagnosis.
"Boss Zheng, your standard is really high," Professor Yang praised. "Tell me, how did you see it?"
Zheng Ren felt that it was a little strange. Professor Yang was like this with an autologous liver transplant?
However, he saw that Professor Yang was focused on watching the radiographic films and seemed to be speaking from the bottom of his heart. He did not think too much about it and smiled.
"You're not involved in interventional surgery, so you don't know much about the images of interventional surgery," Zheng Ren said. "The patient had an interventional embolization. Look here. From the image of the iodine oil deposition after the embolization, there is only the embolization necrosis focus. The typical liver cancer focus is not shown on the image."
"Very few liver cancer patients will show this kind of image. In addition to the patient's medical history, he has had intermittent abdominal pain for many years, and he had a history of splenectomy 22 years ago, so I judge that the possibility of an ectopic spleen implantation is higher. "
Professor Yang looked at the radiographic films. Zheng Ren's words had solved a few of his questions, but the reason was not very sufficient.
Zheng Ren's words could most likely deny liver cancer, but the spleen implantation could not be denied.
"Boss Zheng, if it's a spleen implantation …"
"The 64-slice CT scan before the surgery showed that the lesion site was evenly enhanced in the arterial phase, while the venous phase was slightly enhanced. The angiogram showed that the branch of the hepatic artery supplied this round blood-rich tumor. There's no mistake in suspecting liver cancer at this time, "Zheng Ren said as he picked out another radiographic film from the bag.
"After the surgery, the strengthening of the arterial phase of the nuclear MRI was not obvious, but the metastatic lesion on the abdominal wall showed the opposite characteristics," Zheng Ren said. "Because the blood vessels of the abdominal wall lesion are relatively thin, there was no embolization treatment. This is very similar to the image after the interventional embolization of the large spleen."
The interventional embolization treatment of large spleen cirrhosis could effectively increase the number of white blood cells and platelets.
Although Zheng Ren had never done it before, he was close to the peak of interventional surgery. This kind of 'small surgery' was like the back of his hand.
"So, I'm very sure that the local doctor performed a splenic embolization surgery," Zheng Ren said with a smile.
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