Chapter 786 - 366: Tumor Within a Tumor—Bizarre Persistent High Fever and Chest Pain (Part 2)

Chapter 786: Chapter 366: Tumor Within a Tumor—Bizarre Persistent High Fever and Chest Pain (Part 2)

The initial treatment for pharyngitis had no effect on the patient.

Then the treatment was switched to addressing typhoid fever.

Various antibiotics and oral chloramphenicol were used, but there was no significant improvement. The high fever persisted.

Li Jingsheng had gained some new insights.

The standard of county hospitals varies, and the diagnostic level of this county hospital was indeed quite questionable.

Actually, this is a sad reality for many local health clinics and county hospitals, where doctors don’t know how to diagnose but only mechanically perform tests.

They would take an X-ray, test the blood, urine, and stool, and when no problems are found, the doctors start doubting their lives.

Among the fifty-one textbooks studied in school, none taught how to diagnose when all test results are normal but the patient is still ill.

Pharmacology is all about medication, its use for various infections and diseases, precautions, pharmacology, etc.

Medical parasitology teaches about the symptoms following a parasitic infection and the methods for testing...

But encountering situations where test results are normal means... no illness.

Sometimes at the outpatient department, you can hear arguments between patients and doctors.

"Why would I come to your hospital if I’m not sick?"

The patient would yell in anger.

The doctor, looking aggrieved, would say, "But all your test results are normal, you’re truly not sick."

Such arguments are not uncommon.

The experience of this 18-year-old boy at the county hospital must be quite similar. If it weren’t for the persistent high fever, the doctor might indeed claim he’s not sick.

The patient’s pulse is 123 beats per minute, and blood pressure is only 92 systolic and 68 mmHg diastolic.

Systolic pressure between 90-139 mmHg and diastolic pressure between 60-89 mmHg are considered normal ranges for adults.

Though the blood pressure of this young man appears normal,

there’s a slight tendency towards low systolic and diastolic pressure.

This situation actually indicates a brewing issue within the body, albeit not very apparent.

Li Jingsheng noticed the admission time; it was already the fourth day since admission.

The first attending doctor was not Lian Tao.

It was likely someone from his team.

Cases that the attending doctor couldn’t handle would surely be passed to the chief or deputy chief physician.

The boy’s condition was indeed perilous. Any further delay might lead to severe complications.

Lian Tao likely just took over and hasn’t had the chance to identify the cause yet.

He was overwhelmed daily and could only spare limited time for each case, which was understandably challenging.

Bringing Li Jingsheng over this time was timely to share the workload a bit.

After all, the patient couldn’t afford to wait, and the longer the delay, the smaller the chance of patient recovery.

The patient’s white blood cell count is only 5.7 times 10 to the 9th power per liter.

Firstly, this white blood cell count is within normal range.

But with the patient having a persistent high fever for over a month, could the immune system possibly be non-functional?

Clearly, it’s not possible.

High fever itself is a signal that the body’s immune system is working overtime.

The most common causes leading to high fever are viral, bacterial infections, or inflammation somewhere in the body.

For instance, the most common tonsillitis can quickly cause a fever.

The patient’s urine protein shows a significant abnormality with a "++" sign.

White blood cells are also abnormal, way above the normal value.

No abnormalities were found in the stool test.

Blood non-protein nitrogen is 48 mmol/L, carbon dioxide binding capacity is 22 mmol/L, and sedimentation rate is 26 mm/H.

Chest X-ray revealed a left-sided pneumothorax with liquid.

Moreover, there was mediastinal emphysema.

The X-ray showed the left lung was compressed by at least 30%.

There was also a small amount of effusion.

This raises a question: why did the county hospital’s X-ray show normal while the People’s Hospital’s X-ray showed a problem?

Is it because the chest was normal during the diagnosis at the county hospital, with the condition having progressed in recent days leading to abnormalities in the X-ray, or was it due to outdated equipment and unskilled radiologists at the county hospital failing to detect the issue?

Based on Li Jingsheng’s experience in running a clinic, it’s likely the latter.

Outdated equipment, unskilled doctors, and a lack of experience.

After thoroughly reviewing the patient’s symptoms, medical history, and test results, he began a comprehensive diagnosis on the patient.

Li Jingsheng is adept at diagnosing in Pulmonary Medicine, Gastroenterology, or Cardiovascular Medicine.

His first suspicion was whether the patient had sepsis?

The symptoms the patient presented closely resembled Gram-negative bacterial sepsis.

However, how do you explain the left pneumothorax and accompanying mediastinal emphysema?

Without evident external injury, air entering the mediastinum usually does so from the lung parenchyma to the hilum, causing mediastinal emphysema.

Li Jingsheng has fairly extensive clinical experience in this area.

Mediastinal emphysema is usually caused by a pneumothorax.

But what caused the pneumothorax?

He started quickly formulating a retroactive differential diagnosis in his mind.

Analyzing the patient’s X-rays, it’s highly likely that emphysema or a ruptured pulmonary bulla caused the pneumothorax. With the high fever persisting for over a month, evident toxic symptoms in the body are inevitable.

Considering the possibility of sepsis is warranted.

What was the cause of sepsis?

The real cause of the pneumothorax still needs further investigation and cannot rely solely on inference for a definitive diagnosis.

At the very least, some solid evidence is needed.

"Brother Lian Tao truly has a tough job; none of the cases given to him are simple."

Critically, Lian Tao is also a head of two departments.

He’s in charge of not only Pulmonary Medicine but also complex cases in Gastroenterology.

If we accurately define this patient’s condition, it’s no longer just Pulmonary Medicine, but more appropriately termed Thoracic Medicine.