Correspondent Xuan Yanyan Xu Jinlong
Recently, 18-year-old Xiao Xie (pseudonym) has had ups and downs in life: repeated chest pains, coughing for many months without improvement after taking medication, and finally coughing up blood. The chest X-ray examination revealed shadows in the lungs, which did not rule out the possibility of lung cancer. Then he went to the Department of Respiratory Medicine of the Second People’s Hospital of Quzhou City. After the doctor peeled off the cocoon, he found that the culprit was “an extra lung”. At present, Xiao Xie has successfully completed the operation to recuperate at home, and the haze shrouded in the family’s heart has finally dissipated.
The 18-year-old senior high school student has a lump in his lungs
Xiao Xie’s story starts from a month ago: this morning, Hu Jun, the director of respiratory medicine who arrived in the clinic ahead of schedule, was sitting Then, a pale, anxious mother pushed the door and walked in. She closed the door, approached Director Hu and said in a low voice, “Doctor, I brought my son here to see a doctor. He may have lung cancer. I didn’t tell him, please don’t tell him what’s going on for a while, please!” “Okay, let him come in.” Although full of doubts, many years of clinical experience made Hu Jun decide to see the patient first. Say it again.
Xiao Xie, tall and thin, is still in the third year of high school. After “catching a cold” half a month ago, he began to have coughs and sputum symptoms, and sometimes felt a dull pain in the lower left chest. Because the symptoms were relatively mild and did not affect daily life, and the third year of high school was heavy, Xiao Xie and his mother did not dare to relax at all, so this incident did not attract attention, and only bought some “anti-inflammatory drugs, cough medicine” in the pharmacy phlegm syrup” and other drugs to treat.
After taking the medicine for a week, the above symptoms did not improve significantly. One day, Xiao Xie suddenly coughed out a mouthful of blood while eating lunch, which frightened his mother and hurriedly took him to the nearest hospital for treatment. The community hospital took a chest X-ray for Xiao Xie, and found that there was a mass shadow about 3 cm in diameter in his lower left lung, so he informed the parents that there was a lump in the child’s lung, and the possibility of lung cancer could not be ruled out. It is recommended to take him to a higher-level hospital. Go have a look, so the scene at the beginning of the text appears.
Multidisciplinary consultation and treatment turned out to be pulmonary sequestration
Hu Jun patiently asked Xiao Xie about all suspicious symptoms since the onset of the disease, and carefully read his chest X-ray and found that his There was indeed a circular mass in the left lower lung near the pleura, so Xiao Xie was advised to complete the chest CT examination. The CT image results clearly showed that Xiao Xie had a 3.5 cm × 3.8 cm cystic and solid mass in his left lower lung, and there were some infectious exudative foci around it. Cough, chest pain, hemoptysis, lung mass… It seems that everything is a reminder of the misfortune of this teenage boy suffering from a serious disease, but Hu Jun feels that everything is possible before he obtains the basis for the pathological diagnosis! He decided to admit Xiao Xie to the hospital for further examination and a clear diagnosis.
After admission, the respiratory medicine team discussed and analyzed Xiao Xie’s condition. According to past diagnosis and treatment experience, percutaneous lung biopsy is a direct and reliable means of diagnosis and treatment for peripheral lung masses to obtain ideal histological specimens for histological diagnosis, and Xiao Xie’s condition seems to meet this condition. But Hu Jun raised objections at this time. He believes that from the chest imaging of this patient, although the lung mass needs to consider the possibility of lung cancer, there is a similar cystic structure in the periphery, which is still somewhat different from the more typical lung cancer tissue, and the lesions are closely related to blood vessels, blood supply Abundant, rash puncture may have a greater risk of bleeding, and the plan needs to be carefully formulated.
“What do you think is a 18-year-old young man with no smoking history, how high is the risk of developing lung cancer? When we see a doctor, we often only pay attention to the lesions and ignore the main body of the patient. The age, different occupations, and even different genders are closely related to the disease, and it is necessary to comprehensively see and analyze to get the most correct diagnosis and treatment plan.” Hu Jun reminded the department staff to adopt a personalized diagnosis and treatment plan.
Afterwards, Hu Jun invited experts from the hospital’s radiology department, pathology department, thoracic surgery department, oncology department and other related departments to conduct a multidisciplinary discussion on Xiao Xie’s condition, and formulated a safe and effective method for him. diagnosis and treatment plan, and suspended percutaneous lung biopsy. On the basis of active anti-infection and symptomatic treatment, Xiao Xie further improved the relevant auxiliary examinations. The reconstruction of thoracic angiography showed that the blood vessels in the lung lesions were dense and tortuous, and they were closely related to the aorta. At this time, everyone felt scared for a while. If a lung biopsy was rashly performed before, the risk of massive bleeding would be extremely high, and even life-threatening! Percutaneous lung ultrasonography also confirmed the presence of cystic adventitia, which clearly demarcated the lesion from normal lung tissue. With the feedback of the test results one by one, the shadow of a rare disease gradually surfaced, and the culprit turned out to be it – pulmonary sequestration!
After the diagnosis was confirmed, Xiao Xie was transferred to the Department of Cardiothoracic Surgery of the Second Hospital of Quzhou for thoracoscopic surgery. The lesions were completely removed. The intraoperative pathology also confirmed the diagnosis of pulmonary sequestration, and the postoperative recovery was good. . Fortunately, it was not lung cancer. Fortunately, the 18-year-old sky was not overshadowed. Fortunately, I met a group of medical staff with superb medical skills and strong sense of responsibility from the Second Hospital of Quzhou. Xiao Xie and his family finally fell down.