I Can See Health

"Is it possible that the sonographer's skills are not good enough?" Jin Miao whispered.

"Are you talking about which hospital's ultrasound department is not good? The one in our hospital or the one in another hospital?" Lu Chen asked in return.

"This..." Jin Miao paused.

This patient's ultrasound examination in another hospital showed congenital heart disease.

However, no abnormality was found during the examination at this hospital.

If there is a question of quality, it can only be said that the quality of the doctors in our hospital is not good.

But in the field of ultrasound, the level of the ultrasound department of Guanghai No. 1 Hospital is ahead of the city, and even the 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 sixties.

I was admitted to the hospital because of palpitations and shortness of breath for 2 months, which worsened for 1 week.

After 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 walked into the ward.

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

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

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

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

"Okay, please, director."

Although the patient looked unhappy, he still nodded slightly.

"Turn sideways a little."

Before performing a cardiac ultrasound, the patient needs to lie on the left side at a 45-degree position, which will help reduce the impact of lung gas on the ultrasound image.

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

Many previous diagnoses relied on Lu Chen's skill, which was no weaker than that of a professional sonographer.

…

After a while.

Lu Chen took back the ultrasound instrument.

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

"Everything is normal." Lu Chen said calmly.

"Ah? No congenital heart disease?" Jin Miao was stunned.

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

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

Since Lu Chen's ultrasound results and those from our hospital are the same, the only explanation now is that the examination results from another hospital are wrong!

Lu Chen frowned and did not express his thoughts easily.

"Let's 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 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.

"What disease are you mainly considering for this patient just now?"

As a bedside doctor, Jin Miao was the first to say: "The patient was admitted to the hospital with chest tightness. A physical examination on admission revealed that the jugular veins were full and a small amount of fine moist rales could be heard in both lungs. Based on the patient's laboratory examination, heart failure is currently considered to be the main cause. As for the cause of heart failure, coronary heart disease has not been ruled out for the time being. After three days of treatment, the patient’s condition has improved a lot.”

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

Gu Xinyue did not reply immediately. She looked at the patient's test report and 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, then said: "D-dimer, do you suspect pulmonary embolism?"

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

"But among patients with heart failure, some people also have elevated levels of D-dimer!" 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 who was standing aside, "Director Lu, you just asked, does this have anything to do with the patient's abnormal heart ultrasound result?"

The main contradiction currently facing the patient is the inconsistency of the cardiac ultrasound.

"Of course it does matter!"

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

"What does it have to do with it?" 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 with confusion.

Lu Chen smiled slightly, "Do you think it's possible that the results of these two ultrasound examinations are both normal?!"

"All...are all correct?" Jin Miao's face was full of disbelief.

In less than a few days, congenital heart disease disappeared? Cured?

When Gu Xinyue heard this, she 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 aim.

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

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

Upon seeing this, Jin Miao immediately raised his question.

This could be explained if the patient had a congenital heart disease occlusion surgery.

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

Before Lu Chen could say anything to explain, Gu Xinyue was suddenly born.

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

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

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

Why are we suddenly talking about pulmonary embolism again?

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

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

Gu Xinyue continued: "To put it simply, the first ultrasound report did not actually indicate congenital heart disease. The most intuitive result was that the heart had a right-to-left shunt and the right heart pressure increased sharply."

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

Gu Xinyue said: "However, UU Reading www.uukanshu.net 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. Sometimes cardiac ultrasound cannot completely distinguish between the two!

"I know!" At this point, Jin Miao finally had an idea and said excitedly: "The patient's patent foramen ovale usually does not have any symptoms, but when there is a pulmonary embolism, the right heart pressure increases sharply, and it will It causes right-to-left shunting, which looks like 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 in the right heart decreased, and the atrial shunt also disappeared. Therefore, the repeat cardiac ultrasound became normal!"

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

The link-by-link clinical diagnosis and treatment thinking makes Jin Miao more and more excited.

This feeling of enlightenment is difficult for outsiders to feel.

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