Everyone discussed for a long time, and then turned their eyes to Chen Qi, wanting to hear the opinions of the dean.

Bian Meng is more jumpy, and he is Chen Qi's cronies, so he was the first to ask:

"Chen Tou, what do you think is the condition of this patient?"

Chen Qi stood in front of several X-rays lined up and pondered for a while, and then said something that surprised everyone:

"I think it's an inflammation."

"Ah???h

Everyone in the office was surprised, if it weren't for Chen Qi being the dean, it is estimated that many people would have booed.

What are you kidding about inflammation, is there inflammation that lasts for 3 years?

How can it be?

Director Bian of the Department of Surgery couldn't help it, and asked rhetorically:

"If it's inflammation, repeated anti-infection treatment for 2 weeks, and the best antibacterial drugs in the provincial city, how can it not be absorbed at all?"

"Yes, if it's inflammation, why hasn't the shadow of the patient's lungs changed much in the past 3 years?"

"yes, look at this film, the boundaries of this shadow are not very clear, if there is inflammation, the edges should be very clear."

With Director Bian at the beginning, everyone began to refute it, anyway, it was you Chen Qi who said it, don't be afraid to say the wrong thing when discussing.

Only Yan Shifan was thoughtful and continued to look back at the film.

Chen Qi saw that everyone didn't believe it, so he patiently explained:

"Then let's take stock, first of all, everyone thinks that lung masses and lung abscesses can be ruled out. The diagnosis of pulmonary tuberculosis is generally accepted as the most consistent, but anti-tuberculosis treatment is ineffective, so only inflammation is the most likely, right?"

Everyone was just about to say something, but Director Bian made a silent motion.

"But inflammation is the most unlikely diagnosis in everyone's opinion, because the time is wrong, 3 years. And because there has been anti-infective treatment, the same effect is not great, so everyone doesn't even dare to think about this possibility, but everyone thinks about it, don't look at the time, just look at the film and clinical symptoms, does it look like inflammation?"

Zhang Xingshun interjected at this time: "But looking at this film and clinical symptoms, it is similar to tuberculosis."

Hush~~~~

Everyone in the office laughed wildly and cheered Chen Qi's inversion one after another.

Chen Qi didn't care, and was sincerely happy that everyone had such a relaxed atmosphere that did not worship authority.

"When I say it's inflammation, the first thing that comes to everyone's mind must be a lung infection, or pneumonia, right?"

Everyone nodded, how many meanings does the lung infection foci have?

"Okay, let's review the X-rays of pneumonia first, the first and most common is pneumococcal pneumonia, the patient can show thickened lung markings in the early stage, and as the disease progresses, it can appear to be a realistic shadow, right?

You have noticed that in this consolidation shadow, you can see the bronchial airway signs, and some patients can have a small pleural effusion due to the inflammation that spreads to the pleura, causing an inflammatory response to the pleura, do you see this patient?"

Everyone shook their heads in unison.

Chen Qi talked about internal medicine knowledge, which was still relatively unfamiliar to surgeons, so everyone listened very carefully.

"Then let's look at a very common staphylococcal pneumonia in clinical practice, which is an acute purulent lung inflammation caused by staphylococcal invasion, which can be shown by X-ray examination of the consolidation of lung segments and lobes, or lobular infiltrates, with single or multiple fluid sac cavities. ….

Pay attention, the liquid air sac cavity, everyone has also seen the film, this characteristic manifestation patients do not have, so staphylococcal pneumonia can also be ruled out, no problem, right?

There are other types of pneumonia, such as mycoplasma pneumonia, which can manifest as multiple forms of infiltrative opacities with a segmental distribution, mostly in the lower lobes of the lungs, or extending outward from the hilum.

If pneumonia is caused by a viral infection, the lungs may appear ground-glass opacities, which may appear in both lungs. In addition, patients with novel coronavirus pneumonia can also have patchy shadows, which are mainly distributed in the extrapulmonary zone, which is very tolerant

It is easy to develop white lung ......"

Director Bian suddenly raised his hand and interrupted:

"Wait, I know other types of pneumonia, what is the new coronavirus pneumonia? Why haven't I heard of this disease?"

Chen Qi was shocked, thinking that he had leaked out about a world-wide COVID-19 epidemic in his previous life.

"Uh, don't care about these details, this is a kind of pneumonia just researched and invented by the United States, and it has not yet been officially applied in clinical practice, and it is normal for you surgeons not to know, cough cough, where did I talk about?"

Wang Yuelei reminded, "Chen Tou, you talked about the different image manifestations of pneumonia."

"Oh yes, you see, we have done the elimination method one by one, is there no pneumonia that matches Jin Wenyao's film? So the diagnosis of pneumonia, we can also rule it out."

Now everyone is even more confused, thinking that you say that it is an infection and inflammation of the lungs for a while, and then say that it is not pneumonia, what kind of trouble is this?

Are you the dean, you have the final say?

Chen Qi couldn't get angry when he saw everyone's confused, questioning, and surprised eyes:

"It's really not bad to say that you are rough old men in surgery, is there only one kind of lung inflammation? You don't think about the surrounding foci of infection caused by a foreign body in the lungs?"

Zhang Xingshun was unconvinced:

"Chen Tou, you said that it is a bronchial foreign body, which is common in clinical practice, but you want to say that the foreign body in the lungs, and it is still in the patient's right middle lung, how can there be a foreign body in this place? How did the foreign body fall into the right lobe?"

"That's it!"

There was another burst of questioning from the crowd.

Why are you questioned? It is precisely because they are doctors that they will directly doubt Chen Qi's statement.

It is possible for foreign bodies to be inhaled into the lungs through the mouth and trachea, especially if they are smaller.

For example, some small grains of rice, small plastic grains, small screws, or small legumes such as mung beans may pass through the trachea and enter the lungs.

Then there can be infection and inflammation in the lungs, or long-term irritating cough, fever, chest pain, and sometimes asthma attacks.

In acute cases, dyspnea, cyanosis, etc., and in severe cases, hypoxia may occur, causing respiratory failure.

From this point of view, Jin Wenyao's symptoms are indeed very similar, and the symptoms can be explained.

However, the premise for this to be inhaled into the lungs is a small foreign body, at most the size of a mung bean.

Some large foreign bodies, such as coins and larger toys, usually do not enter the lungs through the bronchi, and in most cases enter the gastrointestinal tract through the throat and esophagus. ….

Let's take a look at the shadow of Jin Wenyao's right lung, which is an oval-shaped high-density shadow, and the longest diameter reaches 1, so even if there is a foreign body in this shadow, it must be at least 6.

This is clearly illogical.

In this way, everyone in the case discussion will talk about your opinion, and I will say my observations, and no one can convince anyone.

So the problem is back to square one, you can't make a clear diagnosis, how to treat the symptoms?

Modern medicine is about evidence, you can put forward all kinds of hypotheses, but you must have auxiliary tests to prove that your point of view is correct.

Just like the police arrest a thief, you know that the thief has broken the law, and you police cannot convict on the basis of suspicion, so it is easy to misgrasp and misjudge, which will lead to adverse consequences (medically it is misdiagnosis)

So you have to find evidence that the thief stole something, so that you can convict the thief and restore peace to the community.

Thinking of this, Chen Qi was also helpless.

Jin Wenyao's illness was imminent, and they were not allowed to guess like this.

According to Chen Qi's previous practice in Huangtan, that is, regardless of 3721, he will directly open a knife after anesthesia first, and see what is inside?

But now it's not good, one is that he is the dean, and the dean has to take the lead in standardizing diagnosis and treatment, and he can't do what he wants like before.

The second person

The Jin family is bad, keep an eye on it, and if you are not satisfied, it is estimated that you will walk at the gate of the county government, and the advanced of the four courtyards this year will not be mentioned.

What to do?

Chen Qi knocked on the table and thought of an idea, anyway, the Jin family's treatment costs money, and it is not his Chen Qi's money, why save it for them?

So he looked at a few subordinates in the office and had an idea:

"Yang Tihao, Zhang Xingshun, give the two of you a task to send this Jin Wenyao to the First Affiliated Hospital of the Provincial Province, the equipment of the people is advanced, and let the family help us do a few inspections. When the results come out, you will come back with the patient."

Chen Qi is now as close as a family to the First Affiliated Hospital of the Province, making the Fourth Hospital like a branch of the First Provincial Hospital, doing a few inspections, and it is not that the inspection fee is not paid.

"Okay Chen, what kind of tests should I do?"

"CT, Lung Function, Oncology Indicators, Biochemistry ......"

Chen Qi counted his hands one by one, and if he said the same more, it meant that the Jin family's wallet was going to start bleeding again.

Don't look at these examinations are very common in later generations, and the price is not expensive, but in the 80s, these are all new things, and the cost of examinations is naturally not for the whole family.

Just a CT scan costs a few hundred yuan a time, and a farmer only earns a few hundred yuan a year in this year? But you can't help it, no matter how expensive it is, you have to do it, and you have to open the back door and line up to do it.

Who told the tens of millions of people in the province to have only one CT? Who says that the clinical value of CT is so unique?

It is estimated that some people will question Chen Qi's medical ethics, why do you have nothing to do with the Jin family spending so much money? Aren't you a miracle doctor? You can touch it twice and you'll know it.

Chen Qi will definitely give him a look:

It's okay? Why are you going to the hospital if it's okay? It's okay that you haven't been cured for 3 years? You have to make a clear diagnosis, these tests are all necessary to do, love to do it or not, don't do it. ….

When the Jin family heard that they were going to the provincial capital for a comprehensive inspection, this made the second daughter-in-law and the younger daughter-in-law feel distressed, and they thought that the few brick mansions in the family would not be able to be saved.

So he looked at the old father pitifully.

In order to maintain the dignity of the Jin family in the village and the clan, the three sons are not separated, the property is shared, and the family is Jin Kangsheng himself.

Luo Cuifeng was very happy, anyway, it was not her personal money that was spent, but the money in the family's account, which meant that their big house was taking advantage of other people's two and three rooms.

At this time, let alone going to the provincial capital, even if she goes to the capital, she won't blink her eyes.

Jin Kangsheng is a family member, so he naturally knows his family's economic situation, and a baby grandson has been sick for 3 years, and it can only be described as having no money in the family for 3 years.

(Not to mention 1986, even if there is a three-year long illness in 2020, unless there is a mine at home, no one can stop it)

But the old man knew in his heart that this was also his grandson's last chance, after all, Chen Qi had almost 100% cured of the patients he had handled so far.

Thinking of this, Jin Kangsheng gritted his teeth:

"Boss, if you go back to the village now, go and borrow money, and use our house as collateral, and borrow 2,000 yuan first, oh no, 3,000 yuan. If you can't borrow so much, you can secretly withdraw some of it from the family's public account, so that the people in the village don't know."

The boss of the Jin family nodded and ran away.

The second daughter-in-law of the Jin family couldn't help it: "Dad, we won't be able to live in the future without a house?"

The little daughter-in-law is already covered with frost, she doesn't say a word, she has already calculated it in her heart, this family will be divided sooner or later, the sooner the better, there is a good saying, the dog that will bite does not bark......

Jin Kangsheng sighed and comforted the two daughters-in-law:

"Dad, there is no way to do this, Xiao Yao is the only male baby in our family after all, but Dad promises, this is the last time, Chen Qiken makes a move, Xiao Yao's illness will definitely be cured, and there is no need to spend this unjust money in the future."

The second daughter-in-law stomped her feet and left the ward with a straight face.

In this way, the Jin family prepared the money, and the doctors of the fourth hospital took Jin Wenyao to the provincial hospital for a walk.

Provincial Affiliation

First Hospital, Outpatient Building.

Director Xu Jinxing of surgery saw all the information of the patient, especially the X-ray film several times, and then suspiciously pulled Yang Tihao and Zhang Xingshun, two young doctors from the Fourth Hospital of Vietnam, who accompanied the patient, to a piece.

"What are you Dean Chen doing? It's so simple that all tuberculosis patients are sent for CT?"

Yang Tihao and Zhang Xingshun, look at me, I look at you, a little confused, why is the big expert and "master" in the provincial city also diagnosed with tuberculosis?

Yang Tihao hurriedly reminded:

"But Director Xu, we have treated this as tuberculosis before, but the result is ineffective, so when we discuss it in the hospital next, we ruled out the situation of tuberculosis."

"You rule out tuberculosis diagnosis?"

Director Xu was a little unconfident, so he returned to the front of the reader, carefully flipped through a few films, and his mind was full of question marks:

"No, whether it's the patient's clinical symptoms or the X-ray results, you see this thing doesn't look like a tuberculosis ball, well, it's a little bigger, but it can't be ruled out that it's tuberculosis, right? By the way, what do you Dean Chen think?"

Yang Tihao replied a little embarrassed: "Let's Chen Tou said that inflammation is more likely."

Xu Jinxing almost squirted out a mouthful of tea, if it wasn't for Chen Qi's words, but if other doctors explained like this, he would have scolded his mother.

"Inflammation? Up to 3 years of inflammation? Inflammation that doesn't respond to anti-inflammatory treatments? Chen Qi is looking away this time, right?"

Grilled dumplings