I really don't want to be a doctor

Chapter 167 Type I Mezzanine

"Actually, at the beginning, we didn't pay much attention to the patient's chest CT."

Teacher Cao took out the patient's chest CT film from the information bag in his hand.

In ordinary chest CT, everyone's attention is focused on the patient's lungs to identify whether there is an infection focus.

Because ordinary CT cannot show blood vessels very well, few people pay attention to the changes of blood vessels.

"It's just that the calcification plaque on the patient's aorta is too strange." Mr. Cao said.

"Aortic calcification?" Li Wenlin said, "Ms. Cao, isn't this normal? Many elderly people have it."

Aortic calcification is mainly caused by metabolic disorders such as blood pressure, blood lipids, and blood sugar.Long-term elevated blood pressure can lead to vascular endothelial damage.If the patient has high blood sugar and high blood lipids, it can promote lipoproteins, cholesterol, triglycerides, foam cells, and macrophages to form thrombus at the damaged site and cause aortic calcification.

Calcified plaques can be easily identified in chest CT. The blood vessels are black, and the white spots are calcified plaques.

"Calcified plaques are normal, but calcified plaques that appear regularly on every section are abnormal!"

Teacher Cao spread out the chest CT and showed Jing Xiaoran and Li Wenlin the calcified plaques on the aorta.

"Have you found out this pattern?" Teacher Cao said.

Jing Xiaoran stared carefully at the chest CT image, "The calcifications in each section appear at a relatively fixed position, and all the calcifications are connected together, like a series of white lines, dividing the aortic lumen into true and false. Cavity!"

"Xiao Jing, your observation skills are really good." Teacher Cao praised, "And you just verified it with ultrasound, the patient's aorta is widened."

This seems very simple, but it is very different to actually do this in clinical work.

Even many old doctors who have worked for many years may not be able to find out.

"Mr. Cao, what should we do next for this patient?" Li Wenlin said.

"Ms. Zhu Zhu is currently communicating with the patient's family. For the time being, she will definitely not be able to go directly to the emergency department." Teacher Cao said, "At present, the most important thing is diagnosis. Judging from the current chest CT and ultrasound, they are only auxiliary diagnosis and cannot confirm the diagnosis."

"The most important thing now is to perform aortic contrast-enhanced CT (aortic CTA), which is the gold standard for diagnosing aortic dissection."

Later, Teacher Cao slightly adjusted the patient's doctor's order.

Most patients with aortic dissection are caused by long-term elevated blood pressure, so the most important medical treatment is to control blood pressure.

……

Cardiology intensive care unit, interview room.

"Doctor Zhu, do you mean to go out for a CT scan?" The female family member didn't quite understand Zhu Zhu's words, "But in the documents I brought before, there is already a chest CT scan from a week ago, why do I need to do it again?"

"It's different this time." Zhu Zhu patiently explained, "We suspect that the patient has aortic dissection, so we need to go out to do this aortic contrast-enhanced CT."

The female family member still didn't seem to understand, and said puzzledly: "Dr. Zhu, I remember that when I was first admitted to the hospital, you said that my mother had an acute myocardial infarction. Why is it now a dissection?"

"Family, it's like this. I said at the time that it was probably acute myocardial infarction, but I didn't deny the possibility of other diseases!"

Zhu Zhu took out the Informed Consent Form that must be filled out for admission to the hospital, which included the common causes of chest pain.

After hearing the words, the female family member asked after a while: "Then is this aortic dissection serious?"

"It's very serious. Sudden death may occur at any time." Zhu Zhu said seriously.

The severity of aortic dissection is related to the type. According to the location of the dissection breach and the extent of the dissection, it can be divided into three types.

Type I: The tear is located within 5 cm above the aortic valve, involving the aortic valve proximally, and involving the aortic arch, descending aorta, abdominal aorta, and even the iliac arteries distally. Type II: The location of the breach is the same as type I, and the dissection is limited to the ascending aorta. Type III: The breach is located 2 to 5 cm away from the opening of the left subclavian artery, involving the iliac artery distally.

"Ah, will this disease cause sudden death?" The female family member clenched her fists, her eyes fixed on Zhu Zhu.

Zhu Zhu nodded: "Yes. Aortic dissection is caused by high blood pressure and unhealthy blood vessels, which cause the intima and media of the aorta to rupture, and blood enters between the intima and media."

"If the damaged opening is too large and the amount of bleeding is large, hemorrhagic shock may occur at any time."

The female family member was startled when she heard this, "Doctor Zhu, how can this dissection be cured?"

"Once aortic dissection is diagnosed, all we can do in the Department of Cardiology is to control blood pressure. The real way to treat the root cause is to go to the heart surgery department for thoracotomy."

Aortic dissection is divided into A and B types according to the needs of the operation. Type A: The tear is located in the ascending aorta, suitable for emergency surgery. Type B: The dissection is limited to the abdominal aorta or iliac artery, which can be treated with medical treatment first, followed by open surgery or endovascular treatment.

"Thoracotomy in Cardiac Surgery?" The female family member's face suddenly turned pale, "Then, what is the success rate of the operation? How much is the cost?"

"The operation fee for cardiac surgery is about 40 yuan." Zhu Zhu said, "The success rate of our hospital is about 50%, and the probability of different cardiac surgeons is not the same..."

"Doctor Zhu, I want to ask." The female family member suddenly interrupted: "I mean, if this aortic dissection does not undergo surgery, how long can the average person live?"

Zhu Zhu frowned and said, "Aortic dissection is like a ticking time bomb. If surgery is not done, as I said, there is a risk of sudden death at any time. Of course, some people with chronic aortic dissection may live for 20 years. "

"Doctor Zhu, have you ever seen this kind of patient with chronic aortic dissection?" asked the female family member.

"I've seen a few." Zhu Zhu nodded slowly, "But even so, their quality of life is very poor, they already have symptoms of chest pain, and they have to worry about whether the dissection hole will continue to grow."

"If the diagnosis is aortic dissection, I still recommend active treatment, and I will help you contact the director of cardiac surgery."

The female family members frowned, and then sighed deeply.

"Thank you, Dr. Zhu, let my mother do this examination first. For surgery, wait for the results of the examination."

The expression on Zhu Zhu's face didn't change at all, and she said, "Okay, I'll arrange for the patient to go downstairs for an examination right away, and you need to be with you all the way."

After speaking, Zhu Zhu left the interview room.

This patient was taken by Jing Xiaoran to the first floor for CTA of the aorta.

In the operating room of the CT room, Jing Xiaoran saw the results just after the patient had a CTA of the aorta.

Unfortunately, this patient had type I aortic dissection.

The breach is located within 6 cm above the aortic valve, the proximal end involves the aortic valve, and the distal end involves the aortic arch, descending aorta, abdominal aorta, and even the iliac artery and renal artery!

(End of this chapter)