MTL - Doctor’s Life Simulator-Chapter 19 Very rare Cobb's syndrome
While Qin Lang was looking at the documents, footsteps came from outside the conference room, and it was Wu Youtu who walked in with the other two attending physicians.
The one on the left is a female doctor. She is the attending physician of the Pediatric Internal Medicine Department of the First Hospital of the City, Physician Yu. She is a very senior doctor and is very experienced in diagnosing and treating children.
The other man on the right is Dr. Zhang, the chief physician of neurosurgery. He is also very accomplished in clinical practice and has a lot of surgical experience.
The two doctors have a strong aura, and I have to say that any attending physician in the city's first hospital is very powerful.
When Qin Lang saw the three attending physicians coming in, he naturally got up and put down the documents.
Seeing Qin Lang, such a young doctor attending the meeting, Dr. Yu and Dr. Zhang were a little surprised. Generally speaking, with Wu Youtu's habit, a young doctor would never be allowed to attend the meeting.
As a woman, Doctor Yu instinctively looked at the handsome little doctor in front of him, with a very soft and kind smile on his face.
After all, he is a doctor in pediatrics, and he is like a spring breeze, but his heart is an iron wall.
There is a saying in the medical world, called: Golden ophthalmology, silver surgery, exhausted obstetrics and gynecology, greasy and crooked internal medicine, pediatrics is not worth a penny, don't go to the emergency department if you die!
In response to Doctor Yu's gentle gaze, Qin Lang also smiled and guided the two doctors to their respective seats.
"You two, take a look at the patient's condition first. After a while, Zhong Chengfa's treatment arrives, and we will start a formal consultation."
Wu Youtu sat down at the chairperson's seat, and then whispered to Qin Lang to sit next to him:
"Listen to my report for a while and cooperate with the projection. Then, listen to the analysis of the attending physicians and organize the minutes of the meeting."
Qin Lang nodded, and naturally understood that this was a very good learning opportunity given to him by Wu Youtu.
Qin Lang also wanted to know what the cause of this little girl was, and it was hard to see her suffering.
After a while, Zhong Chengfa also rushed to the conference room. After signaling to Dr. Zhang and Dr. Yu, he sat down and saw Qin Lang, very cordial:
"Xiao Qin, I will also participate in the discussion for a while. If you have any ideas, you can also mention it."
Regarding Zhong Chengfa's attitude, the two attending physicians on the side were a little strange. When did Zhong Chengfa treat the little doctor so kindly.
Could it be that this little doctor has a very hard backstage and has an extraordinary relationship?
It's not enough, they don't have the heart to guess Qin Lang's identity now, and they still focus on the patient's condition, which is really a bit puzzling.
When Wu Youtu saw everyone, he also started this multi-department consultation.
"The specific situation must have been seen by several of you. Here are some of the latest photos and physical examination materials."
Wu Youtu sent the latest photo to Qin Lang through his mobile phone, and let him play it through the projection.
The three attending physicians also looked at the past. The little girl is now more than two months old. It is very intuitive that there is obvious subcutaneous pigmentation on the back and adjacent areas, as well as obvious vascular moles.
This is also the reason why the previous treating physician judged it to be a hemangioma.
Wu Youtu pointed to the latest physical examination and pathological slides:
"Due to the sudden aggravation of her condition, it is obvious that the previous diagnosis of a simple hemangioma is untenable. Two days ago, I took a pathological section on her, which showed that the patient had lipoma-like tissue, tumor-like hyperplasia of blood vessels and adipose tissue. Striated muscle and nerve tissue can be seen..."
Qin Lang cooperated with Wu Youtu's words, constantly switching to enlarge the photos and details.
"Ulcers have developed in the perineum due to irritants such as feces, urine, friction and maceration..."
As the photos were played, the atmosphere in the conference room became more and more solemn.
Dr. Zhang from neurosurgery took the lead in asking:
"Mr. Wu, now I can't get a specific conclusion with only a preliminary physical examination. I suggest doing another MRI!"
As for Dr. Zhang's proposal, Wu Youtu naturally thought of it.
"Because it was considered to be a simple hemangioma before, and the symptoms were mild, MRI examination was considered after 4 months."
"After all, the patient was still a baby, and MRI was expensive, time-consuming, and difficult for the baby to cooperate with, so I considered doing an ultrasound of her skin and spinal cord first."
Wu Youtu's thinking, of course, has his reasons, but ultrasonography is only a temporary method after all, and the missed diagnosis rate is high.
However, this is the only way to go for now, and several people check the latest ultrasound results together.
"Everyone, is it possible that it is a lipoma, or a space-occupying lesion in the spinal canal?"
Physician Yu from the Pediatric Internal Medicine Department put forward her opinion, and I have to say that it is still very possible.
"Looking at the results of this ultrasound examination, you can roughly see that there is a hemangioma next to the spinal canal of the patient, and the vertebral body has bone destruction, the density is reduced and the structure is unclear."
Dr. Yu's ability to watch movies is very strong, and she is well-known in the city's first hospital, which is one of the reasons why Wu Youtu invited her.
"Look, the patient's spinal cord is squeezed and displaced by a dilated aneurysm and venous lake in the spinal canal, like a space-occupying lesion..."
Listening to Dr. Yu's analysis, Dr. Zhang and Wu Youtu both zoomed in on the film and examined it carefully.
"Yes, as expected of Dr. Yu, it is most likely a space-occupying lesion in the spinal canal."
Physician Zhang's spirit is also relaxed a bit. As long as he has a general direction, he can follow this inference and find further evidence.
"Now that the direction has been initially determined, let's do an MRI!"
Wu Youtu nodded: "Okay, let's first consider the treatment plan according to the space-occupying lesions in the spinal canal, and go for the MRI examination at the same time."
After having the direction, everyone finally felt a little better.
Qin Lang also became much more relaxed from his nervousness. Watching the consultations of so many attending physicians really made him learn a lot, and at the same time, he was full of yearning. When would he be able to treat his patients like this? Diagnose and cure the disease!
Just as the meeting was coming to an end, a familiar electronic voice suddenly sounded in Qin Lang's mind:
[New task: Use life simulation to discover the real cause of the patient, and at the same time guide several attending doctors to give the correct treatment direction. Prevent patients from missing the best time for treatment due to misdiagnosis. Mission reward: 2 life simulation points. 】
[Do you want to enable simulation for a single patient? 】
Hearing this voice, Qin Lang's expression changed naturally. He didn't expect to start a multi-department consultation. So many attending physicians still made the diagnosis in the wrong direction.
Qin Lang lowered his head and started the simulation:
[You were invited by Wu Youtu to participate in the multi-department consultation. At the meeting, several attending physicians, because the patient's symptoms were too rare and misled by the superficial symptoms, gave a wrong treatment plan. UU reading www.uukanshu.com]
[Three days later, the MRI examination report came out, but because several people were limited by their own ideas, they only noticed the symptoms of the spinal canal space-occupying lesions, while ignoring several other hidden diseases. Therefore, according to the wrong treatment plan, the patient has been unhealed for a long time. Two months later, the patient developed abnormal bleeding and steal blood...]
[Three months later, the patient died. The family members of the patient made a riot in the hospital, and Wu Youtu and others were very frustrated and uncomfortable. After the late symptoms before the patient's death, Dr. Yu discovered the truth of the patient's death. The patient's real cause is the extremely rare Cobb's syndrome! 】
[After the incident, Wu Youtu, a physician in the organization department, jointly analyzed the case and gave the basis for the judgment of Cobb's syndrome, as long as there are 3 of the following 5 items: (1) skin or subcutaneous tissue hemangioma, brown skin Moles or flaky café-au-lait spots, and may be accompanied by other congenital malformations, such as double stem spinal cord, butterfly vertebra or meningocele, etc.; (2) vertebral hemangioma; (3) paravertebral hemangioma; (4) spinal canal Epidural hemangioma; (5) intramedullary vascular malformation. 】
[At the same time, it is also proposed that spinal cord angiography is the gold standard for the diagnosis of this disease, which can comprehensively display the location, volume, flow rate, feeding arteries and draining veins of abnormal blood vessels, as well as the relationship between the abnormality and adjacent vascular structures (especially spinal cord blood vessels). The source of blood supply and venous drainage of malformed vascular mass, etc...]
[Single-case simulation is over: you will gain experience in diagnosing Cobb's syndrome. 】
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In the entire conference room, when everyone got up and started to clean up, suddenly a sudden voice sounded:
"Chief Wu, physicians, I have another idea that I would like to share with you!"
