Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Seeing this, Lin Yi quickly stopped and said:
"Ma'am, don't move around! The catheter hasn't been fixed yet, if you move around, it may cause massive bleeding!"

After the woman heard what Lin Yi said, she immediately lay down obediently, not daring to move anymore.

After fixing the catheter, Lin Yi said:

"Okay, the operation is over, and the patient can be transferred to the observation room."

"The next step is to perform minimally invasive interventional treatment on the other two diseased microvessels according to the patient's recovery."

"But then don't worry, Borui, you can take charge."

"it is good!"

After coming out of the operating room, Lin Yi, Song Borui, and Chen Qiaoya were called to the office by Zhou Chao, the director of their emergency department.

"Come, sit!"

Seeing the two of them coming in, Zhou Chao immediately greeted them.

"A patient has been transferred from the Thoracic Surgery Department. Let me tell you about the situation."

"A 46-year-old female patient was admitted to the hospital a few days ago due to edema of both lower limbs and face, accompanied by anorexia, abdominal distension, dyspnea and fatigue."

"Eight years ago, the patient underwent cardiac pacemaker implantation due to acute viral myocarditis complicated by Aspen syndrome, and the pacemaker was not removed after the operation."

"In April last year, due to symptoms such as lower limbs and facial edema, angiography of the inferior vena cava was performed in another hospital, which indicated that the superior and inferior vena cava were narrowed."

The effect of balloon dilatation was not good twice successively, and the electrocardiogram was generally normal during hospitalization.

You don't need to look much to know that patients are frequent visitors to the hospital, and the lesions are also old lesions.

After reading these, Wang Qiaoya fell into deep thought.

The disease of this patient is a bit difficult for her, although she has studied all these diseases in medical school.However, such a complex combination of these diseases did not have enough clinical experience for her.

But Lin Yi turned around and asked.

"Director Zhou, is there any report of the patient's examination results within 24 hours, I want to see it."

Zhou Chao said.

"There are still a few test results that haven't come out yet. I asked Wu Qian from our department to keep an eye on them. As soon as the results from the Laboratory and Imaging Department come out, Wu Qian will send them over immediately."

After a while, Wu Qian hurried over, handed over the patient's examination report to Zhou Chao, and then flew away.

However, before leaving, she still did not forget to smile sweetly at Lin Yi.

It seems that the lobby is really busy...

Zhou Chao held the report card, and Lin Yi and Wang Qiaoya also came over.

The patient's 24-hour dynamic electrocardiogram showed normal sinus rhythm. Venous CT showed long stenosis of the superior vena cava, circular stenosis at the place where the inferior vena cava enters the right atrium, and azygos vein collateral circulation.

Echocardiography showed that the inferior vena cava near the right atrium had a wire-like echo accompanied by significantly faster venous blood flow, and the maximum venous blood flow rate was 163mm/s.

After three people read it, two were worried.

It seems that the Department of Thoracic Surgery has indeed turned a very difficult case around.

After watching the CT images for a long time, Lin Yi said to Zhou Chao.

"But with these test results, I feel that it is not enough to find the real focus of the patient's disease, and I suggest another test."

Zhou Chao raised his head and asked.

"Do you want to perform superior and inferior vena cava contrast on the patient?"

Lin Yi couldn't help smiling.

"I thought of a piece."

Hearing what the two of them said, Wang Qiaoya couldn't help but frowned.

"Hey! You two, shouldn't you also explain to me why the superior and inferior vena cava is performed?"

After hearing Wang Qiaoya's question, Zhou Chao laughed.

"You are lucky today, you have learned a lot from us!"

Wang Qiaoya asked.

"Director Zhou, what's going on?"

Zhou Chao continued to explain.

"Although, Director Zhang Zicheng of the Department of Thoracic Surgery said that the patient's condition was special and he was unable to treat him, so he transferred it to our department."

"However, in my opinion, this patient is very likely to suffer from venous thrombosis or stenosis. This disease is a relatively familiar case to me."

"The patient underwent pacemaker implantation eight years ago due to acute viral myocarditis complicated by Aspen syndrome, and the pacemaker was not removed after the operation."

"Venous thrombosis or stenosis is a relatively common complication after transvenous pacemaker implantation."

"The patient's symptoms are also very consistent with the symptoms of venous thrombosis. I agree with Lin Yi's judgment. I suspect that the patient is obstructed by the superior and inferior vena cava, right? Lin Yi?"

Lin Yi nodded.

"That's why I said to do superior and inferior vena cava contrast for the patient."

Through such an explanation, Wang Qiaoya understood the intentions of these two people.

"If angiography of superior and inferior vena cava is done, can the cause of the patient be confirmed immediately?"

Lin Yi nodded.

"That's it!"

After making the decision, Zhou Chao turned around and communicated with the patient's family.

The communication process is very easy, after all, patients and their families are very cooperative.

Soon, they came to the operating room, ready to perform superior and inferior vena cava contrast for the patient.

The results of the angiography were almost consistent with the judgments of Lin Yi and Zhou Chao.

Because the guide wire could not pass through the patient's superior vena cava, Zhou Chao was changed to indirect contrast of the superior vena cava.

After angiography, it can be clearly seen that the patient's long segment of the superior vena cava is narrowed, where the azygos vein joins the entrance of the superior vena cava.Angiography of the inferior vena cava showed that the obstruction was at the place where the inferior vena cava merged into the right atrium, where the wire was seen to be twisted.

Seeing this result, both Lin Yi and Zhou Chao breathed a sigh of relief.

At least, it can be confirmed what the cause of the patient's recurrent attacks is.

I also learned why director Zhang Zicheng transferred this patient to the emergency department.

The case of superior and inferior vena cava obstruction made Zhang Zicheng difficult because of two points.

The first point is the old lesions that have recurred for many years and have a long medical history.

The second point is that the patient's pacing lead is implanted, which is tantamount to increasing the difficulty of the operation.And repeated balloon dilatation has been implemented many times, but the results are all invalid.

If you want to perform surgery on the patient, you must use extracorporeal circulation.

This again increases the possibility of postoperative complications in patients.

Just now, Zhou Chao was still chatting and laughing.However, when he thought of the surgical plan, he couldn't help but have a headache.

What can patients do if their narrowed veins don't respond to balloon dilation?
"Director Zhou, what's the matter?"

Seeing Zhou Chao like this, Lin Yi couldn't help asking.

"Although I am familiar with this case, I have also determined that the patient is caused by obstruction of the superior and inferior vena cava. However, the patient has also undergone multiple balloon dilations, but none of them are effective."

"So, what else can we do?"

"If a pericardial patch is used, I'm afraid it will still be laughed at by the thoracic surgeon... unless the azygous patch is used for repair."

Zhou Chao expressed his concerns.

Lin Yi couldn't help smiling after hearing this, and said:

"It's nothing, don't worry too much about this issue, I have a measure."