Recently, I saw a female patient in the outpatient clinic. She suffered from repeated hemoptysis. She was very frightened, because there was a large or small lesion about 2cm in the right lung from the lung CT scan. Obviously this lesion It was the cause of her hemoptysis. The most important thing was that the lesion became larger after anti-infective treatment.
According to the conventional thinking of diagnosis and treatment, bronchoscopy or lung puncture should be performed for her to confirm the diagnosis. The current diagnosis cannot be made by film alone, especially if it looks like inflammation, but For cases that do not improve after anti-infective treatment, it is impossible to diagnose the problem without further examination. Considering that the bleeding is still present, lung puncture may aggravate the bleeding, so first choose to do bronchoscopy. If there is bleeding, it can be passed through. Bronchoscope timely injection of hemostatic drugs to stop bleeding.
The bronchoscope was inserted and found that the wall of the trachea was swollen and the orifice was relatively narrow, so the possibility of lung cancer could not be completely ruled out. I put some saline in and rinsed it out, and divided it into several parts. Some of them were sent to check for cancer cells, some for tuberculosis smear microscopy, and some for fungal-related tests in the laboratory. Finally, they were sent for gene sequencing with the consent of the patient.
The results came out in two days, and the gene sequencing result was Aspergillus, a fungus that can grow into a lump-like appearance after infection, and can also cause bleeding, but no other results. If a special abnormality is found, if the gene sequencing is not performed, and the treatment does not improve, lung puncture or even surgical resection should be considered.
Clinical examination has a weakness, that is, if the pathogen is dead in the specimen we take out, it is difficult to detect it with other examinations such as culture or smear microscope observation, but gene sequencing Yes, because no matter whether the pathogen is dead or alive, the genetic material exists, and sequencing will amplify a small amount of genes and amplify the number, so as long as a trace amount of pathogens can be clearly detected.
