I Can See Health

   Chapter 803 Both lists are correct!

   "Could it be that the ultrasound doctor is not very skilled?" Jin Miao whispered.

   "Which hospital's ultrasound department is not good? Our hospital or another hospital?" Lu Chen asked back.

   "This..." Jin Miao paused.

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

   However, in the inspection of this hospital, we did not see any abnormality.

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

   But in the field of ultrasound, the level of the Ultrasound Department of Guanghai First Hospital is to lead the city, even the whole province.

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

  Jin Miao immediately briefly described the patient's condition.

   The patient is a female patient in her 60s.

   He was admitted to the hospital because of palpitations and shortness of breath for 2 months and aggravated for 1 week.

  Besides admission, except for 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 entered 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 the director of our department, Lu, who came to see the patient."

   The patient's family was amazed at Lu Chen's age, but they still respectfully called out "Director Lu".

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

   "Okay, sorry for the trouble, Director."

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

   "You turn your side a little."

   Before performing a cardiac ultrasound, the patient is required to lie on the left side at 45 degrees, which helps to reduce the impact of lung gas on the ultrasound image.

   Jin Miao was very convinced of Lu Chen's ultrasound technology.

   Many previous diagnoses were made by Lu Chen, who was not weaker than a professional sonographer.

  …

   After half an hour.

  Lu Chen took back the ultrasound instrument.

   "Director, how is it?" Jin Miao said quickly.

   "Everything is normal." Lu Chen said lightly.

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

   "No." Lu Chen shook his head, "My results are similar to the results of the patient's examination in our hospital."

   "That's because there is something wrong with the ultrasound results in the outer hospital!" Jin Miao said flatly.

   Since the ultrasound results of Lu Chen and this hospital are the same, the only explanation now is that the examination 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 instrument and returned to the doctor's office.

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

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

   "For the patient just now, what is your main concern at the moment?"

As a 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 beside him, "What do you think?"

  Gu Xinyue didn't reply immediately, looked at the patient's test sheet, 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 looked at it, and then said: "D dimer is 6.11ug/ml, do you suspect pulmonary embolism?"

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

   "But heart failure patients, some people also have elevated D-dimer!" Jin Miao said.

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

  Jin Miao nodded, and suddenly looked at Lu Chen beside him, "Director Lu, you just asked, does it have anything to do with the patient's abnormal cardiac ultrasound results?"

The main contradiction of    patients at present is mainly the inconsistency of cardiac ultrasound.

   "Of course it does!"

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

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

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

  Gu Xinyue also looked at Lu Chen with a puzzled expression.

  Lu Chen smiled slightly, "You guys say, is there a possibility that the report results of these two ultrasound examination sheets are both normal?!"

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

   In just a few days, congenital heart disease is gone? been cured?

   When Gu Xinyue heard this, she opened the patient's ultrasound sheet and continued to read.

   He knew Lu Chen very well, and it was absolutely impossible for him to say these words without purpose.

"To put it simply, the first ultrasound order in the other hospital was done when the condition was serious." Lu Chen said slowly, "The second ultrasound order in this hospital was after treatment and remission. ."

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

   When Jin Miao saw this, he immediately raised his own question.

   If the patient has had congenital heart disease closure surgery, it can be explained.

   But the patient did not have any surgery at all during this period!

  Lu Chen didn't speak to explain, Gu Xinyue was born suddenly.

   "I see!" Gu Xinyue's eyes showed a hint of surprise, "Director Lu's meaning, the patient suffered from pulmonary embolism?!"

   Lu Chen heard the words, smiled and nodded to Gu Xinyue.

  Jin Miao is even more confused. Didn't he keep talking about congenital heart disease?

   Why did you suddenly talk about pulmonary embolism?

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

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

  Gu Xinyue continued: "Simply put, the first ultrasound report does not actually indicate congenital heart disease. The most intuitive result is that the heart has a right-to-left shunt, and the right heart pressure increases sharply."

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

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

  From an anatomical point of view, the patent foramen ovale is in the same position as the central atrial septal defect, and echocardiography sometimes cannot completely distinguish the two!

"I see!" Having said this, Jin Miao finally calmed down and said excitedly: "The patient's patent foramen ovale does not usually have any symptoms, but when there is a pulmonary embolism, the pressure in the right heart increases sharply, and Causes a right-to-left shunt, which looks like a congenital heart disease, but it's actually just a patent foramen ovale!"

   "After a few days of treatment, the patient's pulmonary embolism gradually improved, pulmonary hypertension disappeared, the pressure in 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 two abnormal ultrasound results.

   The clinical diagnosis and treatment thinking of one link has made Jinmiao more and more excited.

   This kind of epiphany is hard for outsiders to feel.

   (end of this chapter)