"What do you say?" Sun Lien was a little flustered, and he subconsciously asked Cao Yanhua, "Do you want to call Lao Wu first?"

Cao Yanhua frowned and looked at it for a long time, then shook his head, "I'll talk about it when the blood results come out." If an ectopic pregnancy is true, at least β-HCG is elevated. He looked at the strong echo on the screen, his brows furrowed as if he could wring out water. "At least to me, it's not like an ectopic pregnancy. ”

Both men were a little flustered. This kind of ultrasound image is not something that is often seen in emergency rooms. Cao Yanhua took out his mobile phone and was about to call Director Liu to help, but Sun Lien immediately thought of Brother Koro, who had partnered with him before. After calling to invite Brother Luo to come for a consultation, Sun Lien thought about it and sent another message to Xu Yourong. This strange symptom was beyond the scope of his knowledge, and it was the right choice to turn to a higher-level physician.

"Baked gluten!" As soon as the message was sent, Xu Yourong immediately replied, "Got it, I'll take Zhou Ce over with me." ”

The location of the strong echo group is also quite close to the kidney, so it makes sense for Zhou Ce to come for a consultation together. Thinking like this, Sun Lien simply called the pediatrics again. Qian Hongjun, director of pediatrics, had just finished the outpatient clinic and was about to go home, and was also invited by Sun Lien by phone.

"It's very lively. Liu Tangchun squinted his eyes and walked into the rescue room, looking at the doctors in many departments in the rescue room, he felt that things might be very troublesome. He saw that it was Sun Lien who was standing with Cao Yanhua, so he simply asked, "Lien, what's the situation?"

"Director Liu. Sun Lien nodded and briefly introduced the basic situation he had heard. "The situation is quite special, and neither Dr. Cao nor I can confirm the type of echo group, so we asked you to diagnose it. ”

Liu Tangchun walked to the side of the bed and asked for the inspection report that had just been printed, "If it's just an echo group, you shouldn't have called me over." He glanced at the video report and continued to Sun Lien, "Do you think this unidentified mass has anything to do with her mental condition?"

"At the moment I can only make this kind of inference. "But I don't understand why the lump in the lower abdomen causes a nerve response — she doesn't look like a paraneoplastic syndrome." ”

Paraneoplastic syndrome is an immune disease caused by a primary malignancy. When a primary malignant tumor occurs in the human body, the immune system recognizes the cancerous cells, and a large number of antibody cells are secreted to fight the tumor. These antibody cells floating in the blood may mistakenly attack other organs that the cancer has not yet affected, and cause symptoms unrelated to the tumor. And this syndrome basically appears before malignant tumors are detected, and although the symptoms are severe and extremely annoying, they are one of the important clues to the early detection of cancer.

And the reason why Sun Lien directly ruled out paraneoplastic syndrome is also because of this - if it is a malignant tumor, this size is basically certain to be advanced, and metastasis has already appeared. In this case, Ji Youfu may have already had other symptoms, so she would not have been sent to the hospital emergency department by the teacher because she was in a daze.

"It doesn't look like an ectopic pregnancy. Brother Luo, who was called for consultation, put his hands behind his back, stretched his neck, and leaned over to look at the B-ultrasound report printed out by Liu Tangchun's hand. "Ectopic pregnancies generally rupture around forty days, resulting in an acute abdomen and massive bleeding. The presence of a primitive heart tube beat means that the embryo has been developing for at least eight weeks and is not at the right time. And the eight-week embryo is not that big. ”

Qian Hongjun, director of the Department of Pediatrics, rubbed his bald head and put forward 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 ovarian cysts in children. Ultrasound of ovarian cysts shows strong echo masses, which seem to be a real possibility, although the chances of it occurring in a thirteen-year-old girl are low.

"The image is correct, but the symptoms are not. Sun Lien continued to shake his head and deny other people's diagnoses, "The teacher reported that the little girl had a personality change two months ago, can ovarian cysts cause mental symptoms?"

Xu Yourong suddenly opened his mouth and said, "Teratoma?" she pointed to the mass, "It is possible for the teratoma to have a primitive heart tube pulsation, and it can be asymptomatic for a long time. When the teratoma matures, it can trigger an immune response. And the immune cells also attacked her brain......"

"What do you mean......" Liu Tangchun suddenly realized, "Autoimmune encephalitis?"

Autoimmune encephalitis is a miraculous disease. Although it was not confirmed for the first time until 07, and although it was included in the first batch of rare diseases in the country in 18, its incidence rate is not low. In fact, a large proportion of encephalitis, which was previously treated as "encephalitis of unknown cause", is characterized by various classifications. From 10 years, the first case of autoimmune encephalitis was confirmed in our country, and then this disease was introduced into the knowledge system of numerous neurologists. Since 10 years, a large number of patients with autoimmune encephalitis have been diagnosed every year. According to recent statistics, the incidence of autoimmune encephalitis has actually surpassed that of viral encephalitis that can be caused by any one virus.

"The onset of autoimmune encephalitis can be combined with or without tumors. If it is combined with a tumor, it is a teratoma. Xu Yourong went on to explain that there was something wrong with Sun Lien's diagnosis. But it's not his fault. In fact, the correlation between autoimmune encephalitis and teratoma is no more than 40% at most. Moreover, the research and understanding of this disease in the entire medical community is still insufficient, and it is reasonable that Sun Lien cannot be diagnosed.

"So......" Sun Lien pointed to the strong echo block on the report, "this...... Is it a teratoma?" he was still pondering the nature of the echo. If it is indeed a teratoma, Ji Youfu's symptoms are actually not too serious. As a common type of germ cell tumor, the progression rate of teratomas is probably less than 2%. Although it causes autoimmune encephalitis, it is not fatal.

Brother Luo said, "This kind of thing, just do a check." Why don't you make an order and send our department for an emergency MRI?"

Cao Yanhua, as Ji Youfu's attending doctor, is very simple to prescribe an examination. It's just that Ji Youfu's parents haven't arrived at the hospital yet, and only her homeroom teacher can sign. Considering that autoimmune encephalitis is not a particularly urgent disease, he simply decided to wait for the imaging confirmation and wait for the blood test report to come out.

After making an almost definite diagnosis, Liu Tangchun did not leave the rescue room in a hurry, but pulled Sun Lien into the small conference room of the rescue room and asked, "Do you feel a little psychological?"

Sun Lien was still immersed in the excitement of encountering a disease that he had barely heard of, he shook his head, and looked at Liu Tangchun a little blankly, not knowing what Director Liu meant by suddenly saying this to himself.

"You kid. Liu Tangchun knocked on the table and said with some dissatisfaction, "What do you have to hide with me?" Doctor, it is normal for a diagnosis to be wrong when the imaging results are not clear and all the clues in other test reports are lacking. Qian Hongjun thought it was an ovarian cyst. There's nothing to be ashamed of!"

Only then did Sun Lien understand that Liu Tangchun was worried about himself, and he couldn't help but laugh, "Director Liu, I'm still just a regular trainee." Although it is not appropriate to say this, it is normal for inexperienced trainees to make mistakes in this kind of diagnosis, isn't it?"

"I'm mainly worried that you've been going smoothly these days, and I can't accept it if something suddenly goes wrong. Liu Tangchun smiled and shook his head, "But you dare to directly say that Qian Hongjun's diagnosis is problematic, and you already have the courage to make a diagnosis." Very good!"

Sun Lien was a little embarrassed, when he just vetoed Qian Hongjun's diagnosis, he didn't think about it. It's just that I simply feel that Qian Hongjun's inferences and symptoms don't match.

"You dragged that pilot out of the helicopter and avoided a possible crash. The municipal party committee and the municipal government attach great importance to this, and they are preparing to commend you. Liu Tangchun suddenly said, "I want to ask you, do you have any thoughts of continuing your studies in our college?"

Sun Lien was stunned, "But...... I didn't register for this year's graduate exam......"

Liu Tangchun waved his hand and interrupted his speech, "If you want to do it, it must be to let the college do the exemption recommendation." He looked at Sun Lien and asked casually, "If you can be exempted from the exam, do you want to enter neurosurgery and follow Liu Pingchuan, or come to me and be a fellow brother with Zhou Jun?" 8)