"What should I say?" Sun Lien was a little panicked. He subconsciously asked Cao Yanhua, "Should we call Old Wu first?"
Cao Yanhua frowned for a long time and shook his head, "We'll wait until the blood results come out. If it's really an ectopic pregnancy, at least there will be an increase in beta-hcg." He looked at the strong echo group on the screen, his eyebrows furrowed as if he could squeeze out water.
"At least to me, it doesn't look like an ectopic pregnancy."
Both of them were a little panicked. This kind of B-ultrasound image is not something you often see in emergency rooms. Cao Yanhua took out his mobile phone and was about to call Director Liu to help, while Sun Lien immediately thought of the image he had been with before, Brother Kroo.
After calling Brother Luo to come for consultation, Sun Lien thought about it and sent a message to Xu Yourong. Such strange symptoms were beyond his knowledge, so seeking help from a higher-level doctor was the right choice.
"Grill gluten!" Xu Yourong immediately replied after sending the message, "I understand, I'll take Zhou Ce with me."
The location of the strong echo group was quite close to the kidneys, so it made sense to ask Zhou Ce to come for consultation. Thinking of this, Sun Lien simply called the pediatrician again. Qian Hongjun, the director of pediatrics, had just finished the outpatient clinic and was about to go home, and he was invited over by Sun Lien with a call.
.
"It's quite lively." Liu Tangchun squinted and walked into the emergency room. Looking at the doctors from many departments in the emergency room, he felt that things might be troublesome. He saw Sun Lien standing with Cao Yanhua, so he simply asked,
"Li En, what's going on?"
"Director Liu." Sun Lien nodded and briefly introduced the basic situation he heard. "The situation is quite special. Neither Dr. Cao nor I can confirm the type of echo group, so we asked you to diagnose it."
Liu Tangchun walked to the bedside and asked for the inspection report he had just printed out. "If it was just an echo group, you wouldn't have called me over." He glanced at the image report and continued to Sun Lien, "What do you think about this?
Is the unknown mass related to her mental condition?”
"I can only make this inference at the moment." Sun Lien said solemnly, "But I don't understand why the mass in the lower abdomen can cause a neurological reaction. It doesn't look like paraneoplastic syndrome."
Paraneoplastic syndrome is an immune disease caused by primary malignant tumors. When a primary malignant tumor occurs in the human body, the immune system recognizes the cancerous cells and secretes a large number of antibody cells to fight against the tumor.
These antibody cells floating freely in the blood may mistakenly attack other organs that have not been affected by the cancer, and cause symptoms unrelated to the tumor. Moreover, this syndrome basically appears before the malignant tumor is discovered, although the symptoms are serious and extremely severe.
Annoying, but one of the important clues for early detection of cancer.
This is also the reason why Sun Lien directly ruled out paraneoplastic syndrome. If it is a malignant tumor of this size, it is basically at an advanced stage and has metastasized long ago. In this case, Ji Youfu may have already developed other symptoms.
The teacher will not send him to the hospital for emergency treatment just because he is in a daze.
"It doesn't look like an ectopic pregnancy." Brother Luo, who was called for consultation, put his hands behind his back and stretched his neck to look at the B-ultrasound report printed on Liu Tangchun's hand. "Ectopic pregnancies usually rupture in about forty days, causing
Acute abdomen and massive hemorrhage. The presence of primitive cardiac pulsation means that the embryo has developed for at least eight weeks, and the time is not right. And the eight-week embryo is not that big."
Director of Pediatrics Qian Hongjun rubbed his bald head and raised a new point of view, "Could it be an ovarian cyst?" Although ovarian cysts are more common in women of childbearing age, there are also reports of children suffering from ovarian cysts. Ultrasound examination of ovarian cysts
It manifests as a strong echo group. Although the chance of it happening to a thirteen-year-old girl is very low, it does seem possible.
"The images are correct, but the symptoms are not." Sun Lien continued to shake his head and deny other people's diagnostic opinions. "The teacher reported that the little girl had a personality change two months ago. Can ovarian cysts cause mental symptoms?"
Xu Yourong suddenly opened her mouth and said, "Teratoma?" She pointed to the mass, "It is possible that the teratoma has primitive cardiac pulsation, and it can be asymptomatic for a long time. When the teratoma matures, it may
Triggering an immune response. The immune cells also attacked her brain..."
"You mean..." Liu Tangchun suddenly realized, "autoimmune encephalitis?"
Autoimmune encephalitis is a very miraculous disease. Although it was not confirmed for the first time until 2007, and although it was only included in the first batch of rare diseases in the country in 2018, its incidence rate is not high. Low. In fact, a large part of the encephalitis that was previously treated as "unexplained encephalitis" was its various classified manifestations. Since 2010, my country has confirmed the first case of autoimmune encephalitis , and subsequently this disease was introduced into the knowledge system of many neurologists. Since 2010, a large number of patients with autoimmune encephalitis have been diagnosed every year. According to recent statistics, the incidence of autoimmune encephalitis is actually Viral encephalitis has been caused by more than any single virus.
"The onset of autoimmune encephalitis may or may not be combined with tumors. If it is combined with tumors, it is a teratoma." Xu Yourong continued to explain that there was something wrong with Sun Lien's diagnosis. But this was not his fault. In fact, it was a teratoma.
, the highest correlation between autoimmune encephalitis and teratoma is only 40%. Moreover, the entire medical community has insufficient research and understanding of this disease, so it is reasonable that Sun Lien cannot diagnose it.
"So..." Sun Lien pointed to the strong echo block on the report, "This... is a teratoma?" He was still thinking about the characteristics of this echo. If it is indeed a teratoma, Ji Youfu's symptoms
In fact, it is not too serious. As a common type of germ cell tumor, the worsening rate of teratoma is probably less than 2%. Although it causes autoimmune encephalitis, it is not fatal.
Luo Ge said, "This kind of thing can only be known after an examination. You can make an order and send it to our department for an emergency MRI."
As Ji Youfu's attending doctor, it was easy for Cao Yanhua to prescribe the examination. However, Ji Youfu's parents had not yet arrived at the hospital, and the only person who could sign was her class teacher. Considering that autoimmune encephalitis is not a particularly urgent disease, he
I simply decided to wait for the imaging confirmation and wait for the blood test report to come out.
After getting an almost clear diagnosis, Liu Tangchun did not leave the emergency room in a hurry. Instead, he pulled Sun Lien into the small conference room of the emergency room and asked, "Do you feel a bit psychologically disconnected?"
Sun Lien was still immersed in the excitement of encountering a disease that he had almost never heard of. He shook his head and looked at Liu Tangchun with some confusion. He didn't know what Director Liu meant when he suddenly said this to him.
"You kid." Liu Tangchun knocked on the table and said with some dissatisfaction, "What do you have to hide from me? Doctor, it is normal for a diagnosis to be wrong when the imaging results are unclear and there are no clues in other test reports.
Qian Hongjun thought it was an ovarian cyst. It’s nothing to be ashamed of!"
Only then did Sun Lien realize that Liu Tangchun was worried about him. He couldn't laugh or cry, "Director Liu, I'm just a training student. Although it's not appropriate to say this, an inexperienced training student made a mistake in this kind of diagnosis.
It’s totally normal, isn’t it?”
"I'm mainly worried that you've been so used to it these past few days that you can't accept something suddenly going wrong." Liu Tangchun smiled and shook his head, "But if you dare to directly say that there is something wrong with Qian Hongjun's diagnosis, you already have the courage to make a diagnosis.
.Good!"
Sun Lien was a little embarrassed. When he just rejected Qian Hongjun's diagnosis, he didn't think about it. He simply felt that Qian Hongjun's inference and symptoms were not consistent.
"You pulled the pilot out of the helicopter before and avoided a possible crash. The municipal party committee and government attach great importance to this, and they are planning to commend you." Liu Tangchun suddenly said, "I would like to ask you
, do you have any idea of continuing your studies in our college?"
Sun Lien was stunned, "But... I didn't sign up for this year's postgraduate examination..."
Liu Tangchun waved his hand and interrupted his speech, "If we want to do it, we must ask the college to recommend exemptions from the examination." He looked at Sun Lien and asked casually, "If you can be exempted from the examination, do you want to enter neurosurgery?"
Follow Liu Pingchuan, or come to my place and become fellow disciples with Zhou Jun?"