Doctor Zhao, help!

Chapter 84 Extremely rare Takayasu arteritis
Li Mujia, the attending physician in the ICU, and Lin Yi, the attending physician in the cardiac surgery department, are all thinking hard at this moment. This situation, in which all conceivable possibilities have been ruled out from the examination results and clinical symptoms, is indeed very rare and difficult.

At this moment, Zhao Sheng suddenly had an idea and said, "Dr. Li, Dr. Lin, I noticed that the color photo of the patient's heart showed enhancement of the local wall, which may be related to this."

"According to monism, I think there is only one possibility for the patient's current clinical manifestations, and that is Takayasu arteritis. Apart from this, I really can't think of any other possibilities."

Monism is a guiding thinking for clinical diagnosis, which mainly includes two aspects: first, try to use one cause to explain lesions of multiple systems or organs; second, try to use one disease to explain multiple symptoms.

"Takayasu arteritis?"

Lin Yi, the chief physician of cardiac surgery, suddenly felt his eyes light up when he heard Zhao Sheng's words.

"Yeah, why didn't I think that the patient's current symptoms can be explained by heart failure caused by arterial blockage caused by arteritis? This makes sense."

Li Mujia, the attending doctor in the ICU, said with sudden realization after hearing this.

"The patient is a 14-year-old girl, so I think Takayasu's arteritis is the most likely possibility. Now we must do a CTA of the entire artery to confirm the diagnosis."

Zhao Sheng nodded to the two attending doctors and continued.

Takayasu artery refers to chronic progressive non-specific inflammation of the aorta and its main branches and pulmonary arteries, mainly causing stenosis or occlusion in different parts. This disease is extremely rare and is sometimes not seen by cardiac surgeons in general hospitals. You have to encounter this rare disease.

And whole-artery CTA, CTA, is angiography. If it is whole-artery, all the arteries are angiographed.

However, when doing angiography, contrast agent must be injected intravenously to examine the blood vessels throughout the body.

Now the girl Miaomiao may suffer cardiac arrest at any time due to severe heart failure. At this time, it is very risky to do a full vascular angiography!
If one thing goes wrong, during the examination, the worst result is very likely to occur, that is, cardiac arrest!

"Based on the patient's current condition, it would be very risky to do a full angiogram."

Lin Yi, the attending cardiac surgeon, has rich experience in angiography. The patient is now in a state of severe heart failure. If he undergoes full angiography, he will most likely be unable to tolerate it and suffer serious complications.

But without full angiography, this last possibility cannot be confirmed, and targeted treatment cannot be carried out to save the girl's young life, which may be lost at any time.

In other words, if you don't do this examination, you can only watch the girl end her life due to severe heart failure.

However, the risk of doing this examination is also very high. To put it bluntly, it is to take a chance!
"I'll explain the situation to the family. This examination must be done now. Otherwise, the cause cannot be determined, and we will have to watch the patient die chronically due to heart failure."

Li Mujia, the attending doctor of the ICU, made the decision very simply and neatly. As an ICU doctor, you will often encounter such dilemma decisions.

It's like this kind of adventurous inspection or operation. In fact, it's not that big. There is still some hope.

It would be really difficult to encounter a situation where the patient has relied entirely on medical equipment to maintain life, and once the life support device is removed, the patient will die immediately.

In that case, if you have money, you can just use the machine to maintain your life for a few hours or at most a few days, which is very expensive.

But if you don’t maintain it and just give up, your family members won’t feel good.

That's the real dilemma.

"I'm the receiving doctor, Dr. Li, let's go together."

Zhao Sheng nodded to Li Mujia. In this situation, the risk of examination was very high. Zhao Sheng could not let the doctor in charge, Li Mujia, bear this risk alone.

As for Lin Yi, the chief physician of cardiac surgery, he is only here for consultation, and it is not his turn to bear the risk.

"it is good."

Hearing Zhao Sheng's words, Li Mujia looked at him deeply before nodding.

Soon, Li Mujia and Zhao Sheng left the ICU together.As soon as they came out, the couple greeted them. The female teacher had already gone back. It was good to be able to send students to accompany them and stay for two hours.

"Doctor, how is Miaomiao?"

The girl's mother asked with a tearful voice.

"The situation is not optimistic. The heart failure is very serious. Now we suspect that the child has a rare arteritis and must undergo a full angiography examination. This examination usually has no risk, but in the current situation, there is a big risk. The risk is that cardiac arrest may occur at any time during the examination.”

Before Li Mujia spoke, Zhao Sheng said to the girl's mother first.

"Doctor, do I have to do this test?"

The girl's father said with pain on his face.

"Without examination, given the patient's current severity of heart failure, we can only watch her condition get worse little by little."

Li Mujia said regretfully.

For such a young girl, only 14 years old, with a bookish look on her face, she was good at studying and seemed to be well-educated. It would be too cruel for such a beautiful life to pass away like this.

Especially Li Mujia, she can sympathize with this little girl's situation even more, because when she was studying, she was exactly the same as this girl.

The same is true for good looks, good study, politeness and not rebelliousness.

He is a person who truly loves learning.

As soon as Li Mujia's words came out, the girl's mother covered her mouth with both hands, and tears rolled down like beads.

In a short period of time, the girl's father experienced very painful suffering in his heart. He said to Zhao Sheng and Li Mujia: "Doctor, please do a check-up. As long as there is a glimmer of hope, we will not give up!"

"it is good."

Hearing the words of the girl's father, Zhao Sheng and Li Mujia suddenly felt awe-inspiring. Although as doctors, they have encountered this situation many times, but every time, Zhao Sheng and Li Mujia would feel an incomparable sense of responsibility and mission arise in their hearts. feel.

This feeling of numbness on the scalp is difficult to experience without being a doctor.

Half an hour later, the angiography room.

At this moment, Zhao Sheng, Li Mujia and Lin Yi all looked nervously at the senior contrast imaging doctor Miao Jie, who began to inject contrast medium bit by bit into the vein of the girl Miaomiao who was lying on the examination bed.

During the whole process, Zhao Sheng and the other two people had their hearts in their throats, ready to rush to the rescue immediately if any situation happened.

But maybe the girl had some inexplicable luck at the moment, and the imaging process went very smoothly.

When the results of the imaging appeared on the screen, Zhao Sheng and the others heaved a long sigh of relief.

"Yes, it is Takayasu's arteritis. The patient's aortic contour is irregular, the aortic arch and right renal artery are stenotic, the remaining wall is thickened, and the abdominal aortic wall is thickened and enhanced. This is a manifestation of the inflammatory reaction stage."

Lin Yi, who is the most professional in cardiac surgery, said excitedly.

As long as you find the reason, it will be easy to solve!

Zhao Sheng and Li Mujia also looked at each other, something inexplicable flowed between their eyes, and their moods suddenly relaxed.

(End of this chapter)