The B-ultrasound report showed that Luo Qiao's liver and spleen had multiple plaque-like hypoechoic areas. Further abdominal MRI showed multiple irregular signal shadows in the spleen with limited diffusion. Xu Qiu suddenly frowned. This performance is too similar to liver and spleen infiltration caused by malignant tumors. Combined with the swollen lymph nodes discovered by previous palpation - if you consider malignant tumors, it is likely to be lymphoma. Xu Qiu hesitated. The current common diagnostic idea is to schedule a PET-CT to check whether there are multiple bone density changes throughout the body. However, PET-CT is expensive, with one examination costing about 8,000 yuan. Xu Qiu would not conduct this kind of examination casually if there was no definite necessity. Although various examinations had no diagnostic significance, and ultrasound, MRI, etc. pointed to malignant tumors, Xu Qiu still felt something was wrong.
Lymphoma usually occurs in people around the age of 20 and over the age of 55. In addition to lymph node enlargement, there are often mediastinal masses and corresponding symptoms. If the vein or trachea is compressed, cough and chest tightness may occur. Compression of the esophagus causing difficulty swallowing. Compression of blood vessels in the neck causes swelling of the neck and face, etc... However, Luo Qiao did not have these characteristics. Moreover, many patients with malignant tumors lose weight rapidly in a short period of time. But Luo Qiao had a well-proportioned figure, and apart from her complexion, she looked no different from a healthy little girl. For a moment, Xu Qiu was in trouble. … Soon, a joint consultation was held on this case. Doctors from the Department of Infectious Diseases, Department of Hematology, General Surgery and Orthopedic Surgery all came together to participate in the case discussion. When Luo Qiao's information, diagnosis and treatment process, etc. appeared on the big screen, everyone felt troubled. The hematologist was a little unsure and said, "Do a bone marrow examination? These symptoms cannot rule out leukemia." The orthopedic doctor thought for a long time and said: "Dr. Xu's physical examination showed that the patient's wrist joint and many bones were showing pain. Malignant tumors cannot be ruled out - most of the things that can cause bone lesions are inseparable from malignant tumors. . It would be more appropriate to make an appointment with nuclear medicine for a whole-body bone scan.” "Dr. Xu, what do you think?" The doctors' eyes fell on Xu Qiu. Xu Qiu's thinking was interrupted. He came back to his senses, shook his head and said, "Don't consider malignant tumors first." The orthopedic surgeon didn't understand: "The patient's symptoms are almost completely consistent with the symptoms of malignant tumors infiltrating the bones, liver and spleen. There is no reason not to consider it first."
The hematologist nodded. Leukemia is one of the malignant tumors in the hematology department. The discussion lasted for more than half an hour. Eventually, a compromise was discussed. First, a bone marrow puncture was performed on an area with a high degree of bone metabolism in the patient. After the results came out, many doctors who advocated "malignant tumors" were dumbfounded. The puncture did not reveal any tumor cells! At this time, the orthopedic surgeon thought for a long time and said rigorously: "The uncertainty of the impact of bone marrow puncture is too high. If the tumor site is avoided, the result will definitely be negative. Take more samples, or do a biopsy, maybe There will be clearer indications.” But this time Xu Qiu shook his head and rejected further bone marrow examination. "The likelihood of malignancy is low." His intuition told him that Luo Qiao didn't look like a patient suffering from a malignant tumor. He decided to have another physical examination. This has almost become Xu Qiu's habit. It is also the professional quality that a good doctor should have. For patients whose diagnosis direction is unclear, multiple physical examinations must be performed to record changes in condition. Sometimes, symptoms cannot give an answer, but you may be able to find a clue from the progression of the disease! … After arriving at the ward, Xu Qiu conducted a routine physical examination. Fever, around 38 degrees Celsius. Feeling irritable and tired, accompanied by symptoms such as anorexia and nausea. Skin lesions in various stages could also be seen on her body. A fresh rash. The rash develops into blisters. An ulcer formed after a blister bursts. and the temporary pigmentation left behind during the healing process of an ulcer. It is enough to imagine that the patient's disease course will be long. In addition, Luo Qiao has indeed lost weight in the past month, but the degree is not high and has no diagnostic value - any person would lose weight even if he had a fever for a month. "Turn your head to the right."
Xu Qiu palpated the lymph nodes in the left neck again. It was originally just a routine check, but the next moment, his pupils dilated slightly. The patient’s lymph nodes—— It seems to have shrunk! Xu Qiu was not able to accurately measure the change of a few millimeters, but the touch on his hand told him that it seemed to be much smaller than the first palpation. Without hesitation, he quickly called for a bedside ultrasound. Xu Qiu personally applied coupling agent to Luo Qiao and then measured it ultrasonically. The final result shows that the lymph node is 16*8mm! The first result is 20*10cm. A little smaller! Xu Qiu quickly opened the patient's medical records. Strangely, her disease did not improve, yet her lymph nodes shrank in size. This is an unreasonable behavior. "Why……" "Self-limiting disease?" Xu Qiu was a little hard to decide. The fever is still getting worse, but the lymph nodes are slowly recovering. These two contradictory manifestations make Luo Qiao's condition even more confusing. "Brother doctor, okay, are you okay?" At this time, Luo Qiao on the bed rubbed his eyes and asked. She felt so uncomfortable that she just wanted to continue sleeping. Xu Qiu was suddenly startled. He suddenly remembered that Luo Qiao had rubbed his eyes many times since he was admitted to the hospital. This action is easy to be overlooked, and even Xu Qiu did not notice it at the first time. "Do one last check." Xu Qiu pulled some tissues, wiped the coupling agent on Luo Qiao's neck, took out the medical flashlight, and pointed it at the patient's eyes. Both eyes were a little red and red, and lacked the moisture of tears, and looked very dry. "Conjunctivitis?" Xu Qiu immediately linked the ocular manifestations with the rash on the patient. If it was allergic conjunctivitis, it would be enough to explain the skin lesions and conjunctivitis, but other symptoms such as bone abnormalities had no solution.
"Is it viral conjunctivitis?" Viral conjunctivitis often causes enlargement of local lymph nodes. For example, the adjacent preauricular lymph nodes. He palpated again and really found that the preauricular lymph nodes were enlarged! "No, it's not viral conjunctivitis." Xu Qiu shook his head again at this time. The physical examination perfectly matches the manifestations of viral conjunctivitis. However, Luo Qiao had previously conducted a more convincing viral serological test, all of which were negative, and no virus was found! "I already understand the situation. Our hospital will make a clear diagnosis as soon as possible. Take a rest first." Xu Qiu helped Luo Qiao cover the quilt, said a comforting word, and was about to leave the ward. Some of the symptoms just checked were circling in his mind. Aggravated condition, abnormally reduced lymph nodes. Conjunctivitis. Swelling of lymph nodes near the ear... The master-level experience in diagnosing hepatosplenomegaly also played a role at this time, and countless diseases quickly passed by Xu Qiu's eyes. Suddenly, Xu Qiu thought of something, he stopped abruptly, raised his head, and his eyes were slightly bright!