Tanglou looked at the patient through the camera and directly used the diagnostic technique:

[Patient: Ma Wenxuan, male, 3 years old

Symptoms: Cyanosis, dyspnea, heart murmur, acute respiratory distress syndrome and heart failure. Physical examination can reveal tachycardia, tachypnea, hypotension of both lower limbs, cyanosis of the lips, heart murmur and decreased blood oxygen saturation.

Diagnosis: Berry syndrome.

Berry syndrome is a rare combined cardiac malformation that includes the following four characteristic features: aortopulmonary window, abnormal right pulmonary artery originating from the aorta, aortic arch hypoplasia (coarctation or disconnection), and intact ventricular septum.

In 1982, the disease was first described by Berry et al., who pointed out that the incidence of this disease in congenital heart disease was 0.046%. Up to now, the total number of reported cases does not exceed 60.

If diagnosis is delayed, Berry syndrome is fatal, and surgical treatment is the only option that provides the best prognosis.

Special reminder: It is recommended to use i E33 ultrasonic diagnostic instrument, transthoracic echocardiography. CT images are collected by 64-slice multi-slice spiral CT (GE Discovery CT750 HD Systems, United States)]

After reading it, Tanglou was also frightened. After all, the incidence rate of 0.046% is too rare. The total number of reported cases in the world in history has not exceeded 60. The two chief doctors of Zijingang Hospital could not detect it.

Not surprising anymore.

It can only be said that sometimes diagnosis requires not only rich experience, but also a little bit of luck.

[Ding, new task, help Mashua’s little nephew come up with a diagnosis plan and get symptomatic treatment as soon as possible. Task reward: 3 gold coins, the card library is refreshed]

After knowing the truth, Tanglou of course needed some grounding to make his deductions, and he soon came up with a plan.

Tanglou seemed to have a good deal, but he started asking questions carefully. At the same time, he also wanted to talk to Deputy Director Qian about the evidence for Berry syndrome. However, the information was too biased, and Deputy Director Qian did not go there at all.

Thinking about that, there was no response.

The so-called playing the piano to a cow!

Regarding Tanglou's confusing questions, Director Huang frowned with dissatisfaction. Does this young doctor really think he is the invited expert?

It turned out that it was really like a remote consultation, and the two bosses were asked to cooperate.

The two directors of Zijingang Hospital accompanied a resident doctor from Hecheng City No. 1 Hospital for diagnosis. It would be too embarrassing to tell anyone.

Director Huang winked at Deputy Director Qian and asked him to end this farce quickly.

After Deputy Director Qian said a few words, he stopped playing around with the Tanglou.

Tanglou found that it was unrealistic for them to find out by themselves through induction, so they could only roughly break the window paper and pretend to have an idea:

"Deputy Director Qian, have you tested the patient's hemodynamic signs before? Can you show it to me?"

Originally, Deputy Director Qian wanted to refuse, but when he saw Ma Shuya's pleading eyes, he nodded and asked the bedside doctor to provide it.

Ma Shuya held up her mobile phone and quickly scanned the information page by page. Naturally, she felt the impatience of the two directors, and turned around apologetically: "Two directors, why don't you go and do your work first? Tang and I

The doctor will take another look."

Just as Director Huang and Deputy Director Qian were preparing to leave, Tang Lou's voice came from the mobile phone. He seemed very excited: "Stop, I really want to discover the possible cause of the patient's disease."

"Really!" Ma Shuya quickly turned the phone over and almost dropped it. She patted her chest and stabilized it before grabbing it again. She looked at Tanglou and saw Tanglou's expression. Somewhat weird, he coughed slightly and then said, "Looking at these data, it is obvious that the blood flow in the patient's pulmonary artery has increased significantly, and different levels of left-to-right shunting can be detected. I have a guess, but I need to make more progress. Look at the patient’s parasternal long-axis section of the left ventricle and the parasternal short-axis section of the aorta.”

Director Huang and Deputy Director Qian were confused about Tanglou's observations and new requirements. However, after thinking about it, they still satisfied Tanglou's requirements and let him hit the south wall before giving up.

In fact, they had seen these images and information several times. The previous diagnosis of congenital emphysema by Deputy Director Qian was based on the blood flow of the patient's pulmonary artery.

Therefore, in their view, Tanglou is just picking up their wisdom and cannot draw any fresh conclusions.

Soon, according to the request of the tenement house, the little doctor in charge of the bed provided the information.

Ma Shuya turned the camera over again and showed Tanglou carefully.

On the screen, the Tang Tower man nodded like a magician and muttered: "As expected, Doctor Ma, give the camera to the two directors, I have something to say."

"Okay, okay."

When Ma Shuya heard Tang Lou's tone, she obviously made a big discovery, and immediately showed the phone screen to the two directors.

Director Huang looked at the screen, and then Deputy Director Qian squeezed over with his big head, which made him a little unhappy and pushed.

Deputy Director Qian smiled awkwardly, shrank behind Director Huang, and cursed in his heart. What the hell is this? It's like watching an internet celebrity's live broadcast, it's so disgraceful.

"Tell me about it."

After all, Director Huang still wanted to maintain the dignity of the chief physician, so he gave Tanglou a chance to speak.

Tanglou went straight to the point: "I suspect that the patient has the extremely rare Berry syndrome."

"What? What syndrome?"

Deputy Director Qian, who was shrinking behind, asked in confusion, thinking that he had heard wrong. After all, this symptom was too rare, so it involved a blind spot in his knowledge.

However, Director Huang still had some impressions and was a little surprised by Tanglou's association ability, but he did not agree: "Dr. Tang, you are quite brave, but the incidence rate of Berry syndrome is so low, and the patients do not have typical symptoms. I don't think so. I don’t quite agree.”

Due to the diagnosis of Berry syndrome, a lot of symptomatic examinations are required, which is very time-consuming and energy-consuming. Under normal circumstances, when there are other higher possibilities, the most likely solution must be given priority.

After all, Berry syndrome is too bizarre. Spending a lot of work on such a small probability symptom is not a scientific and reasonable way to diagnose it.

When Director Huang denied Tanglou, Deputy Director Qian had already secretly taken out his mobile phone and started Baidu. Then, the first few recommendations Baidu recommended to him were all advertisements for Putian hospitals.

Deputy Director Qian browsed through several pages before he saw the introduction to Berry Syndrome, and became a little uneasy. Is there really such a rare disease?

Berry syndrome, a rare combination of cardiac malformations, requires four characteristic manifestations if diagnosed:

Aorto-pulmonary window, abnormal right pulmonary artery originating from the aorta, aortic arch hypoplasia (coarctation or disconnection) and intact ventricular septum.

This is the "butterfly sign" that is a typical sign of Berry syndrome, that is, in the suprasternal fossa view, the aorta can be detected as severed or narrowed; in the high parasternal view, a patent ductus arteriosus can be seen; in the apical four-chamber view, an intact aorta can be seen

of interventricular separation.

Of course, Tanglou argued with reason. Although the current examination is not enough to confirm the diagnosis, there are still clues: "Through the hemodynamic signs, and the current parasternal left ventricular long-axis section and parasternal short-axis incision of the great artery, it has been confirmed that

Now that there is a certain possibility, I think we can give it a try and investigate according to Berry syndrome! I recommend using the i E33 ultrasonic diagnostic instrument and transthoracic echocardiography."

Ma Shuya's heart skipped a beat when he heard Tang Lou's solid suggestion, although his reason told him that there was not much difference in probability between Tang Lou's speculation and the rest of the investigation directions deduced by Deputy Director Qian and Director Huang, or even lower.

However, it just gave her a sense of unreasonable expectation.

Regarding Tanglou's confident suggestion, Director Huang was also confused for a moment. Is it really what this boy said?

"Director Huang and Deputy Director Qian, we can't confirm the diagnosis now anyway. How about we follow Dr. Tang's direction and investigate?"

Sensing Director Huang's slight wavering, Ma Shuya took advantage of every opportunity and asked.

Deputy Director Qian also looked at Director Huang.

Director Huang thought about it carefully, and finally reason prevailed, and he had never seen any big storms before. He said calmly: "Whether it is based on our suggestions or Dr. Tang's guess, I can only say that both are possible. Of course.

, from my standpoint, priority must be given to conventional diseases with higher probability, rather than gambling, which is an extremely rare Berry syndrome. The final direction of examination still needs to be decided by your family members."

"However, according to Berry syndrome, transthoracic echocardiography is required. CT images are collected by 64-slice multi-slice spirals. Dr. Ma, you are also very aware of the time and energy required. And if the patient is misdiagnosed, one more patient will be misdiagnosed every day.

share the danger."

Director Huang, as a seasoned veteran, is naturally very good at Tai Chi. Moreover, if something does happen, he will completely shift the blame.

Several people looked at Ma Shuya. Ma Shuya hesitated and looked at the screen again: "Doctor Tang, are you really sure?"

Tanglou nodded and said very seriously, "I'm sure."

"good!"

Ma Shuya immediately made a decision for her nephew: "Director Huang, let's do the investigation according to Dr. Tang's reasoning."

Looking at Ma Shuya, Director Huang pondered for a few seconds.

"Then follow Dr. Ma's wishes."

Director Huang did not expect that Ma Shuya would choose to trust such a young Tanglou in front of the two directors. He was a little dissatisfied, so he casually agreed and left coldly.

Deputy Director Qian paused for a few seconds and felt that Dr. Ma was a little confused. He shook his head and followed out, disapproving of Tanglou's inference.

Ma Shuya looked at the two departing directors and felt bad in her heart. She knew that she had offended the two directors, but she admitted it for the sake of her little nephew.

Ma Shuya sighed, but since he decided to believe in Tanglou, he could only take a gamble.
Chapter completed!