"We are holding this discussion today, not so much as a discussion meeting on difficult cases," the laughter below was still in the aftermath, but Qian Fangzhao's face suddenly turned cold, and the words that came out were also murderous, which made the directors and chief physicians of these departments below frightened, "It is better to say that it is a misdiagnosis case discussion meeting, a mistake case discussion meeting!" If it weren't for Ren Jiangchi's timely and correct opinions, I'm afraid we would still not understand the exact cause of Zhao Dongdong's illness!"

Speaking of this, Qian Fangzhao's tone suddenly softened and softened, "Of course, you can rest assured that our current discussion is not to investigate which department or which doctor should bear how much responsibility."

"The main purpose of convening this seminar is to analyze and study this case thoroughly, and figure out what caused the misjudgment in the three consultations before and after, and did not find out the real cause of Zhao Dongdong, so as to sum up the experience and lessons, and after encountering similar cases in the future, he will not fall on the same problem again!

Therefore, everyone should not have any ideological concerns, let alone carry any ideological baggage because of this. In the following discussion process, we must start from our own professional point of view, dare to speak, and put all the factors that may interfere with our correct diagnosis on the table for everyone to discuss and analyze, so as to find out the final answer!

Speaking of this, Qian Fangzhao stopped talking again, pointed to the stack of materials in front of Ren Jiangchi and Fang Shengxue, and said, "This is a copy of Zhao Dongdong's medical record summary and various examination reports. Before you arrived, Director Niu had already given the doctors a brief introduction to the summary of the medical records, do you need Director Niu to reintroduce it?"

Ren Jiangchi asked Fang Shengxue's opinion in a low voice, and replied: "No need to introduce, Zhao Dongdong's situation is our basic situation." And these materials are all on it, and if there is anything we don't understand in the middle, we can look through it at any time. ”

"That's good!" Qian Fangzhao turned his head back, looked around the venue, and said, "Now let's officially start the discussion." Which doctor wants to speak first?"

As soon as Qian Fangzhao's words fell, the female director of the ultrasound department, 48-year-old Xie Mohua, said: "Dean Qian, let me make a speech on behalf of our ultrasound department first!"

"Okay, Director Xie, you say it first!"

"First of all, I want to make a review on behalf of our ultrasound department!" Xie Mohua said, "This time Zhao Dongdong's liver abscess was not detected, and our ultrasound department has to bear a lot of responsibility!"

"Let's not talk about this responsibility!" Qian Fangzhao waved his hand, "Director Xie, what we have to do now is to find out the reason. What is the reason why you did not find Zhao Dongdong's liver abscess when you did the B-ultrasound examination, you mainly talk about this. ”

"The most important thing is that Zhao Dongdong's B ultrasound image is special!" Xie Mohua said, "When Zhao Dongdong was given a B ultrasound examination, there was no abscess cavity or liquid echo on the sonogram, and only a heap-like strong echo area could be seen."

"At that time, the first consideration was whether it was calcification. After inquiry, Zhao Dongdong himself did not have parasitic infection, nor did he have a history of pastoral life, so calcification was ruled out, and then he considered whether it was a relatively aggregated gas.

"Because from the sonogram, the boundary of strong echo is not particularly obvious, which is similar to the gastric gas sonogram we usually see, plus Zhao Dongdong has no fever, no abdominal pain, no vomiting, diarrhea, and normal eating, so he thinks it is ordinary abdominal flatulence, so he only reported the phenomenon and did not consider the liver abscess.

"It wasn't until the results of the CT enhanced scan came out that Zhao Dongdong was diagnosed as a liver abscess, and then the doctor of our ultrasound department compared his CT enhanced scan image with the ultrasound image of abdominal B, and found that the heap-like echo area on the sonogram was completely consistent with the liver abscess in the CT enhanced scan image.

Therefore, the heap-like hyperecho area is the area of liver abscess, because we have never encountered similar signs in the sonographic textbooks of B-ultrasound or in our actual B-ultrasound examination, so we will take it for granted that the phenomenon is reported according to abdominal distention.

And if you carefully compare the sonogram of gastrointestinal gas with Zhao Dongdong's image, you will find that although the two are highly similar, there are also some subtle differences. These subtle differences may be the decisive basis for determining whether a patient has a liver abscess or ordinary flatulence.

"Therefore, our ultrasound department decided to make Zhao Dongdong's B ultrasound image into a classic case teaching material, and conduct an in-depth training within the scope of the whole ultrasound department, so that everyone can accurately grasp the characteristic map of Zhao Dongdong's special B ultrasound image, and the next time we encounter a similar case, there will be no misdiagnosis!"

Qian Fangzhao himself is an expert in the field of internal medicine, and his reading level of abdominal B ultrasound image is not below Xie Mohua. He very much agrees with Xie Mohua's analysis, because even Qian Fangzhao himself, if he did not get the image of the CT enhancement scan for comparison, he also regarded the pile-like echo area on the B ultrasound image as ordinary flatulence.

If he had paid enough attention to this heap-like echo area at that time, and immediately arranged for Pat CT or CT enhanced scan for examination, he would have immediately figured out that Zhao Dongdong was suffering from a liver abscess, which was located in the echo area above the B ultrasound image.

"Director Xie said very well, who else has a different opinion on Director Xie's words, or who has anything to add to Director Xie's point of view?" Qian Fangzhao's gaze swept lightly in the venue.

"I agree with Director Xie's opinion!" said the director of the Department of Gastroenterology, "I also hope that after Director Xie makes the case textbook, he can provide a copy to our Department of Gastroenterology, so that our Department of Gastroenterology can also conduct a comprehensive training." I also attended the previous three consultations, and I was also responsible for the lack of signs of liver abscess on the ultrasound of B-ultrasound!"

"Okay, okay, let me emphasize one thing again. Today's meeting is a discussion of difficult cases, not a meeting of accountability, criticism and self-criticism. Let's all just look for problems, don't do any more criticism and self-criticism!" Qian Fangzhao knocked on the table with his hand and said with some annoyance, "Let's continue the meeting. Does anyone have any ideas to talk about?"

He glanced around, and finally fell on Niu Dabao, and said, "Director Dabao, let's talk about it, what have you gained from this case?"

"Dean Qian, I think that this time I diagnosed Zhao Dongdong with mild septic arthritis, which is both a misdiagnosis and not a mis......diagnosis," Niu Dabao pondered for a long time, and then plucked up the courage to say.

What does it mean to be both misdiagnosed and not misdiagnosed?

Ren Jiangchi met a look with Fang Shengxue and looked at Niu Dabao with interest.

They have learned a lot from the speech of the director of the ultrasound department just now, and what kind of new perspective will Niu Dabao's speech bring to them?