Chapter 785: Ectopic Splenic Implant
Translator: EndlessFantasy Translation Editor: EndlessFantasy Translation
On the radiographic films, the patient did not have a spleen.
What was left in place could be vaguely seen as a scar tissue.
“Yes, I think it was a splenectomy.” Zheng Ren then asked, “Who is the patient to you?”
“My partner,” the middle-aged man replied cautiously.
“How many years ago was the splenectomy performed?” Zheng Ren asked.
“Twenty-two years ago, there was a car accident, and then the splenectomy was performed,” the man answered immediately.
When doctors looked at radiographic films, the first question they asked was about the splenectomy. It was not a mirror image, so there was nothing special about it.
Zheng Ren continued to watch with his chin resting on his hand. The professor stood behind him and also focused on reading the radiographic films.
It had been a long time since he had looked at radiographic films with his boss. This feeling was really great.
A few minutes later, the professor said, “Boss, this liver cancer is a little strange. Why do I feel that it isn’t a cancer?”
“Yes, it is a little strange, but it is hard to say whether it is liver cancer.” Zheng Ren held his chin and looked at the radiographic films. He said, “I highly suspect that it is ectopic splenic implantation and not liver cancer.”
“What?” Rudolf Wagner was surprised. “Boss, how did you see it? Because this part is a little bald?”
As he spoke, the professor pointed at a location with abnormal signals on the radiographic films.
“Not exactly. There’s just some abnormal signals there. Lil Fugui, did you notice that the patient once had an interventional embolization?”
“I noticed it.” When Rudolf Wagner heard Zheng Ren mention the embolization, he seemed to have thought of something. He stared at a few frames of the radiographic films carefully.
Zheng Ren did not continue to explain. It was enough for him to say this much about the professor’s level of reading radiographic films.
The middle-aged man was puzzled.
Would a swindler not say that the more severe the illness, the better? But how could this young ‘doctor’ say that it was not liver cancer?
‘Ectopic implant what?’
‘Was it metastasized?’
With a head full of doubts, his ears perked up. He wanted to listen to the conversation between Zheng Ren and Professor Rudolf Wagner.
However, the two of them fell silent. Without saying a word, they began to ‘communicate’ through the radiographic films.
A few minutes later, the professor clenched his right fist and hit his left palm, making a ‘pa’ sound. The professor and Su Yun had learned this action perfectly.
“Boss, I have figured it out! It is indeed an ectopic splenic implant!” Rudolf said happily.
“Yes, the diagnosis is relatively clear. Especially after an interventional embolization treatment, it is basically confirmed,” Zheng Ren said.
After he finished speaking, he took off the radiographic films and put them into the bag. He said, “Go and find Professor Yang. I will write the diagnosis on the paper later. For this disease, Professor Yang will perform a resection operation. The postoperative pathological diagnosis will be enough.”
As he spoke, Zheng Ren found a piece of discarded A4 paper. He drew a few lines on the front of the paper to indicate that it was invalid. Then, he wrote down his own diagnosis and surgical suggestion on the back of the paper.
The patient’s family was stunned.
He had already sketched out as many possible words that Zheng Ren could say, and he made contingency plans for each of them.
If he was a liar, he knew what he should do.
However, this young ‘liar’ had actually sent him back to the General Surgery Department.
Could he have guessed wrongly?
The middle-aged man held the paper in his hand and carefully read the words on it. He was puzzled.
“Go ahead. I heard from Professor Yang that your lover had pain in her upper abdomen all year round. That was caused by the splenic implantation and the accumulation of liver. It’s not a big deal. It’ll be fine after the resection,” Zheng Ren said as he took out his phone.
He first left a note on Professor Yang’s phone and dialed the number.
“Professor Yang, I’ve finished reading the patient’s radiographic films.”
“Um…”
“Okay, okay. Bro Yang, the radiographic films reveal ectopic splenic implantation, not liver cancer.”
“Yes, yes, your judgment is correct. If there’s a bed, just admit them into the hospital. Do a resection surgery, pathology… During the surgery, you can see that it’s the spleen tissue.”
“Oh, okay, the patient’s family is with me. I’ll bring it up…”
“Okay, then I’ll wait for you.”
After saying that, Zheng Ren hung up the phone.
“Professor Yang… Brother Yang said that he’ll come down later. Let’s wait for a while, so that we won’t run into each other,” Zheng Ren said to the patient’s family.
The patient’s family was dumbfounded. The development of the matter had completely gone beyond his expectations.
Soon, Professor Yang, wearing an isolation suit and a sterile cap, rushed to the Interventional Department.
“Chief Zheng, I don’t think it’s liver cancer,” Professor Yang said hurriedly after he entered the room.
It seemed that he had just left the stage not long ago and did not even have time to change his clothes. It was even possible that he took the time to come down during the intermission of the surgery.
“There is a ninety per cent chance that it is an ectopic splenic implant.” Zheng Ren nodded.
Zheng Ren could not and did not dare to be 100% sure about this kind of thing. If the tumor revealed to be malignant during the surgery, there was no way to explain it.
Without the prerequisite of the gold standard for pathology, Zheng Ren had to doubt the diagnosis.
“Chief Zheng, your standard is really high.” Professor Yang praised. “Tell me, how did you see through it?”
Zheng Ren felt that it was a little strange. One autologous liver transplant, and Professor Yang was just like that?
However, he saw that Professor Yang was focused on watching the film and seemed to be speaking from the bottom of his heart. He did not think too much about it and smiled.
“You are not involved in an intervention, so you do not know much about the image of the intervention,” Zheng Ren said. “The patient had an intervention embolism. Look here. From the image of the iodine deposition after the embolism, there is only an embolic necrotic focus, and the typical liver cancer focus is not shown on the image.
“Very few liver cancers show this kind of image. In addition to the patient’s medical history, the patient had intermittent abdominal pain for many years, and there was a history of splenectomy twenty-two years ago. So, I deduce that the possibility of ectopic splenectomy is higher.”
Professor Yang looked at the radiographic films. Zheng Ren’s words had solved a few of his doubts, but the reason was not very good.
Zheng Ren’s words could probably negate the liver cancer, but the splenectomy could not be negated.
“Chief Zheng, the splenic implantation…”
“The pre-operative 64-slice CT scan showed that the lesion was evenly strengthened at the arterial stage, while the venous stage was slightly strengthened. The angiogram showed that the hepatic artery branch supplied this round, blood-rich mass.
“There’s no mistake in suspecting that it’s liver cancer at this time,” Zheng Ren said as he picked out another radiographic film from the bag.
“After the follow-up examination, the strengthening of the nuclear MRI in the arterial phase was not obvious, but the metastatic lesions on the abdominal wall showed the opposite characteristics,” Zheng Ren said. “Because the blood vessels of the lesions on the abdominal wall are relatively thin, there was no embolization treatment. This is very similar to the post-interventional embolization image of the large spleen.”
The interventional embolization treatment of the large spleen cirrhosis could effectively raise the number of white blood cells and platelets.
Although Zheng Ren had never done it before, he was close to the prime of interventional surgery. He knew this kind of ‘minor surgery’ like the back of his hand.
“So, I’m pretty sure that the local doctor did a splenic embolization surgery,” Zheng Ren said with a smile.