Sun Lien slowly chatted with Liu Baoguo here, and gradually outlined Liu Baoguo's usual life trajectory and appearance. I have to say that it is a very useful means to slowly ask for a medical history like Lao Pa. Sun Lien has gradually grasped a lot of suspicious things in the chat that are not even prompted in the status bar.

What he cares about the most is probably Liu Baoguo's legs.

Liu Baoguo's legs look very strong, and it is not surprising that people who often work in the fields will naturally have very developed leg muscles.

But the shape ...... Not quite right.

Sun Lien palpated his hand a little, and the confusion in his heart became even more serious. Mr. Liu's legs look quite strong, but they feel a little soft when they touch them — not like the touch that a muscular person should have. What's more, the gastrocnemius muscles on the inner and outer sides of Liu Baoguo's calf, which should have been bulging, are not too high, but the soleus muscles look bigger.

This is...... Sun Lien is a little unsure, and the content related to muscles is generally treated surgically. Judging that muscle volume is reduced he is unprofessional.

If this is a decrease in muscle volume...... That's interesting. Sun Lien left the ward, returned to the office and sat down, and began to desperately urge Brother Luo to hurry up and issue a report on WeChat. If it is true that muscle volume is reduced, then the muscle atrophy that occurs in the distal extremity is basically equivalent to announcing that the patient has spondylitis or neurogenic muscular atrophy. However, neurogenic muscular atrophy in general is unlikely to cause persistent high fever, so spondylitis should be the most likely cause.

To diagnose spondylitis, a report from the imaging department is key. Imaging evidence is an important basis for diagnosing spondylitis. It's just that I pity Brother Luo, who was arrested by Sun Lien today.

"I looked at the CT scan and there was no sacroiliitis. It will take some time to issue a report, and Brother Luo was blown up by Sun Lien's head, so he simply reported the situation in WeChat first, "But I did see a little strange place in the sweep." ”

Luo Ge stared at the screen, thought for a while, and then took a photo with his mobile phone and sent it to Sun Lien, "The patient's L4-5 lumbar vertebrae have several hardening points with increased density, this is ...... It's kind of weird. ”

There are high-density sclerosis spots on the lumbar spine, which may be very important diagnostic evidence, but it is also possible that it is just a natural injury in the older body.

This seems to be the diagnosis of orthopedics again. Sun Lien put down his mobile phone and pondered for a while, and the conventional thinking logic told him that he should wait until tomorrow after Yuan Ping'an and they came back to work before organizing a consultation - Liu Baoguo's vital signs were stable, and his condition was not at risk of rapid deterioration, so there was no need to organize an emergency consultation.

But...... Sun Lien can't have anything in his heart. He was more curious than anyone else, even more than the patient himself, about what this disease was.

Just take revenge on Yuan Ping'an. Sun Lien darkened in his heart, who asked you Yuan Ping'an to push my Sun someone out to block the gun before? Sun Lien, the other patient that night, can't remember very well, but the "bath" that the eldest brother with bacillary dysentery gave Cao Yanhua is still fresh in Sun Lien's memory.

"Hey, Doctor Yuan?" Sun Lien's revenge, three or four months is not too late. "I have some ideas about Liu Baoguo's case here, what about you and your sister-in-law?"

"That's right. When Yuan Ping'an answered the phone, he was eating with Lin Yanan in the food stall at the gate of the fourth courtyard. The two of them are both doctors, and it is really time-consuming to cook together. Therefore, on this kind of working day, they either eat a boxed lunch in the department or go to the canteen, or they get together and order two dishes at the food stall at the door. "What do you think?"

"I just chatted with Liu Baoguo, and during the chat, I found that his calves on both sides seem to have some muscle capacity. Sun Lien didn't hide it, and directly said his inference, "I didn't find sacroiliitis on the imaging, and I didn't find that the patient had grape conjunctivitis - but this bilaterally symmetrical muscle volume reduction symptom, I suspect it may be spondylitis." ”

Sacroiliitis and grape conjunctivitis mentioned by Sun Lien are diagnostic features of "ankylosing spondylitis", as a possible autoimmune disease whose etiology is not yet known, ankylosing spondylitis can lead to the fusion of bone in part of the spine, and patients will lose or even completely lose the ability to move part of the spine. And with the development of ankylosing spondylitis, patients will gradually develop symptoms such as spinal deformity.

Ankylosing spondylitis can explain the decreased muscle volume and low back pain, but it cannot explain Liu Baoguo's fever. Therefore, Sun Lien's diagnostic direction and ideas spread to another type of spondylitis - infectious spondylitis.

It is not uncommon for pathogenic bacteria to invade the spine and cause inflammation, including purulent spondylitis, tuberculosis spondylitis, brucella spondylitis and so on. In other words, if it is determined that Liu Baoguo's CT images and decreased muscle volume are indeed manifestations of spondylitis, then we can follow this line of thought to find the source of infection.

"No wonder you asked me in the first sentence if Yanan was there. Yuan Ping'an laughed on the other end of the phone, "Okay, we're almost done eating." I'll pay for it later, and I'll take Yanan back to see the CT image first. ”

Sun Lien chatted with Yuan Ping'an for a few more words, and was about to open his mobile phone to see if he wanted to order takeout, when suddenly he heard a knock at the door, "Doctor Sun, are you there?" was Shen Qingmei's voice.

"Mr. Shen, please come in. Sun Lien replied loudly, and by the way, he quickly clicked a few times on his mobile phone and ordered a yellow braised chicken rice.

"Dr. Sun, come and take a look in the ward. Shen Qingmei stood at the door and didn't come in, she said to Sun Lien in a little anxious, "Mr. Liu suddenly started coughing, and he coughed quite badly." ”

Sun Lien hurriedly stood up and hurried to the inpatient ward with Shen Qingmei. Nurse Xiao Guo saw Sun Lien's movements from the nurse's station and rushed over to help.

"Ahem...... cough, cough, cough!" Liu Baoguo, who was still calm and chatting with Sun Lien just now, was coughing and almost out of breath. His face was flushed with a cough, and it took a while for him to subside a little.

"Mr. Liu, are you okay?" Sun Lien asked cautiously, he took a quick look at Liu Baoguo's status bar, and this time the status bar had changed. "Lung Infection (00.08.13)" appears at the end of the status list, and in front of the Lung Infection prompt, there is a white line, "Spondylitis of unknown cause".

That is, there is nothing wrong with the judgment of spondylitis, and lung infection is ...... Sun Lien frowned, watching the nurse Xiao Guo carefully help Liu Baoguo pat his back - this action helps to expel phlegm.

"Have you coughed like this before?" Sun Lien asked with a frown, long-term fever, lung infection, spondylitis, these three illnesses combined, his first reaction was only two words, "tuberculosis".