novelraw Chapter 362 - 187: All Four Causes Ruled Out, the Final Breakthrough_3
Chapter 362 - 187: All Four Causes Ruled Out, the Final Breakthrough_3
Han Siying earnestly pleaded.
"Of course, that’s no problem."
Li Jingsheng readily agreed.
A little after ten in the morning, while he was diagnosing a patient, his phone beeped several times with messages.
He was busy at the time and didn’t get a chance to check them.
When he opened them, he found they were messages from Lian Tao.
They were further examination results of the patient.
After reviewing them, Li Jingsheng fell into deep thought.
The patient’s condition seemed complex, but if broken down into sections for diagnosis and analysis, it wasn’t that complicated.
The first section, upper respiratory tract.
No abnormalities were seen in the sinuses, the nasal mucosa was normal, and polyps had been surgically removed. So, the upper respiratory tract should be normal, with no disease-induced changes.
The second section, the lungs.
Imaging showed no signs of nodules, multiple sputum samples showed no infection, and there was insufficient evidence of tumors.
Thus, lung cancer could be essentially ruled out.
The third section, the kidneys.
No hematuria, proteinuria, or abnormal impaired renal function was present.
The fourth section, both the anti-neutrophil cytoplasmic antibodies were negative, so immune function disease could also be ruled out.
At this point, the possibility of pulmonary Wegener’s granulomatosis could be essentially overturned.
So what exactly was the patient’s disease?
Li Jingsheng once thought his diagnostic skills in pulmonary medicine had reached Minor Achievement, considering himself quite skilled.
But now, attempting to tackle such highly complex cases made him realize how insufficient his skills were.
The cause, which even top respiratory experts like Director Yang and Lian Tao found challenging, naturally wouldn’t be easy to uncover.
Li Jingsheng’s current level in thoracic diagnosis was Master Level, at least at Attending Level, with some diagnostic experience.
While pondering intensely, he wondered if an infection could be causing the patient’s condition.
The lungs are fairly susceptible to viral, fungal, or bacterial invasion.
For example, tuberculosis can cause changes in the lungs, and early pulmonary tuberculosis imaging looks much like lung cancer.
This patient’s multiple fungal infection tests came back negative.
Last night during the ward rounds, the patient mentioned a symptom everyone had overlooked.
She experienced forehead pain during fever and purulent nasal discharge.
Though not very severe, it was short-lived.
Headache, fever, purulent nasal discharge—aren’t these symptoms of a cold?
Of course, this patient definitely wasn’t having a cold.
It’s unheard of for cold symptoms to last for three months.
What causes a cold? Viruses!
Li Jingsheng thought it might be worth checking the patient’s lung biopsy samples.
"Lian Tao, can you get a specimen from the patient’s lungs to check for viral or bacterial infections?"
"A specimen from the lung lesions?"
Lian Tao almost instantly replied to his message.
It appeared Lian Tao was in a frenzy to crack this case.
"Judging from the scans, there should be nodules in the lungs. Taking samples from these areas should be more accurate. I think we can rule out granuloma at this point."
Tumor and granuloma were both ruled out.
This must have hit Lian Tao quite hard.
"Okay, I’ll send you the results once they’re in."
After responding, Lian Tao went silent.
He must have arranged to take a lung lesion biopsy from the patient.
Just then, the clinic’s ordered fast food arrived.
Taking advantage of the lull, Li Jingsheng quickly ate his meal.
Even while eating, he kept hypothesizing about the patient’s condition.
The CT showed a cavitary mass in the lower right lung, neither a granuloma, lung cancer, nor tuberculosis. What could it be?
It’s as if the lesion was right there, but the specific disease couldn’t be determined.
Medicine is truly elusive like that.
After eating, Li Jingsheng again guided Han Siying to correct some issues in the medical records.
At that moment, a young girl pushed the door open and walked in.
She was dressed even more plainly than Han Siying.
Her face showed signs of illness.
Her spirits appeared low, looking quite haggard.
"Siying, I’m here again!"
She waved and greeted with a forced smile.
"This is my boss, Dr. Li Jingsheng." Han Siying swiftly introduced. "Boss, this is the classmate I mentioned yesterday."
"Hello!"
The girl greeted Li Jingsheng.
"Hello! Since you’re Siying’s classmate, you’re practically a friend. Make yourself comfortable, please sit."
Li Jingsheng personally poured her a glass of water.
She stood up to take it, expressing thanks, but still looked a bit uneasy.
"I have a basic understanding of your situation. It’s mainly diarrhea, correct?"
"Yes, it’s diarrhea and a bit of a fever, a low-grade fever."
She nodded.
"Come, lie down on the bed inside, and I’ll examine your abdomen."
Li Jingsheng said to her.
The best method includes both palpation and instrument examination.
"Siying, come and help."
Whenever examining a female patient, it’s always necessary to have a female doctor or nurse present.
After the girl lay down, Li Jingsheng examined her abdomen.
On her lower abdomen, he observed a surgical scar.
"Is this scar from childbirth?"
"No. I had a kidney stone when I was young, and due to poor medical conditions in my hometown, I had to undergo surgery."
"A urinary stone?"
"Yes!"
Li Jingsheng needed to make sure.
Because this concerns the diagnosis.
Medical history is critical in clinical diagnosis. It’s like a thief caught for stealing is a convict with a record.
Even when reformed and released, there’s a chance of reoffending.
In a theft case, the police first investigate those with prior convictions.
Similarly, doctors, when researching causes, first probe into past medical histories.
Some diseases tend to recur.
Others may lead to complications or sequelae post-treatment.
"Does it hurt?"
"No pain!"
Li Jingsheng continued to press her abdomen.
"Ouch, it hurts, it hurts!"
This time, there was a noticeable tender reaction at the pressure point.