Chapter 788 - 367: Four Types of Pneumothorax Gas Sources, Another Case Solved

Chapter 788: Chapter 367: Four Types of Pneumothorax Gas Sources, Another Case Solved

Also, there is no caseous pneumonia or hematogenous spread lesions in the chest X-ray.

For a tuberculosis patient to progress to such severity, these lesions would definitely be very typical. Thus, the possibility of tuberculosis is almost negligible.

Since it’s not tuberculosis, then how did the pneumothorax form?

Based on the symptoms described by the patient and the progression of the condition, it can be determined that the patient first experienced mediastinal emphysema, followed by pneumothorax. So where did this air come from?

From this direction of inference, the argument that pneumothorax was caused by the rupture of pulmonary bullae or emphysema can no longer be supported.

Under normal circumstances, the air in pneumothorax definitely comes from the lungs, trachea, bronchi, or esophagus.

Recalling the patient mentioned discomfort when swallowing food initially, before it gradually progressed to chest pain and difficulty breathing.

Li Jingsheng believes the air causing the pneumothorax likely does not originate from the lungs.

Then the only remaining source is the esophagus.

Because the human body only has a few channels that allow air intake.

Whether inhaled through the mouth or nose, it is through the trachea or esophagus into the body.

The normal airway is through the trachea, then into the lungs via the bronchi.

But when eating or swallowing with an open mouth, speaking, air can also be ingested into the stomach through the esophagus.

In such cases, as long as the digestive tract is not ruptured, the air has two destinations.

One is passed through the intestines as flatulence, more elegantly termed flatus or gas passing in medical jargon.

A normal person expels quite a bit of gas daily, exceeding 1.5 liters.

Moreover, passing gas is not a bad thing, it actually benefits the intestines.

Another way air can be expelled is through the upper digestive tract and out of the esophagus.

Commonly observed as belching.

The air in this patient’s pneumothorax should not come from the trachea, bronchi, or lungs.

With air leaks from the trachea or bronchi, symptoms are distinctive; an experienced doctor can even hear sounds like whistling or similar to a leaking tire when listening to lung sounds.

If a pulmonary bullae ruptures, that’s much worse.

The patient wouldn’t have been able to delay seeking medical help for so many days.

Besides the rupture of pulmonary bullae forming pneumothorax, there’s another less common condition that can also lead to pneumothorax.

This occurs when a lung abscess penetrates the thoracic cavity.

This scenario is actually also ruled out, as the patient first has difficulty swallowing, then chest pain, and finally difficulty breathing, especially inspiratory difficulty.

Li Jingsheng believes the patient’s inspiratory difficulty is due to the left lung being compressed over 30.

When the lung cannot expand, it means the alveoli cannot expand, preventing fresh air from being inhaled.

In fact, our lungs expand to inhale fresh air into the body, then contract to expel waste gases.

This is the basic working principle of the lungs.

If the patient’s left lung had been severely abscessed from the start, respiratory difficulty or pain would’ve been the initial symptoms.

There might even be cases of coughing up pus or blood.

Thus, just by deducing from the symptoms, the possibility of a lung abscess penetrating the thoracic cavity can be excluded.

Having ruled out several possibilities, only esophageal perforation and air leakage remain.

He assesses that the rupture in the patient’s esophagus should be very small.

Otherwise, not even a week, let alone a month, would pass before the patient succumbs.

The food ingested leaks through the ruptured esophagus into the thoracic cavity, with dire consequences that are frightening to imagine.

The large quantities of food chewed in the mouth, mixed with saliva and juices, contain many oral bacteria; once they enter the virtually undefended thoracic cavity, it’s assuredly disastrous.

The patient didn’t have a high fever initially, but started to develop a fever after experiencing swallowing pain.

This also aligns with Li Jingsheng’s reasoning.

The esophagus might be ruptured, yet the hole is small.

"Take good care and rest! Starting now, temporarily refrain from eating or drinking anything, not even water. Your condition is already very serious; we’ll try to arrange an examination for you tonight."

Li Jingsheng’s diagnosis has become fairly clear.

Now, he needs to persuade Director Lian Tao to arrange a fiberoptic laryngoscopy to examine the esophagus.

Li Jingsheng is about to return to Lian Tao’s office, unexpectedly meeting Lian Tao coming out of the ward.

"Jingsheng, have you personally come to inquire about the patient’s condition? I appreciate your earnest approach. How are things going, any findings?"

"I’ve just learned about the patient’s general condition, and I’ve made some diagnoses. It might be necessary to arrange for an urgent laryngoscopy to check the esophagus. The situation seems quite severe and might be progressing rapidly. The sooner the problem is identified, the smaller the damage."

In the presence of the patient and family, softer terms like damage were used.

Li Jingsheng is painfully aware that if the patient’s condition isn’t diagnosed in time, the probability of death is exceedingly high.

The current situation is already quite grim.

"I knew having you here would ease my worries; the esophageal tumor patient has just been arranged to undergo a puncture. There are only two anesthetists on duty now; I struggled to call in one more. Watching these critical cases progress one by one gives me comfort. Come, let’s discuss this in the office."

Lian Tao accompanies him to the office.

This scene is witnessed by nurses and on-duty doctors in the gastroenterology department, all casting curious looks at Li Jingsheng.

Some people have seen Lian Tao walking side by side with him, like old friends.

But because Li Jingsheng rarely comes to this side, most people do not recognize him.

"Director Lian, who’s this handsome guy?"

"He’s my good buddy, Dr. Li from the Second Hospital."

"He looks so young! Dr. Li, if you’re still single, we have quite a few sisters at the gastroenterology nurse station who are also single! Sweet, salty, cute—we have all kinds of styles."

The short-haired nurse should be about twenty-seven or twenty-eight, wearing a diamond ring on her left ring finger and a necklace around her neck, clearly a married woman.

The main intention of her saying this to Li Jingsheng was to make acquaintances.

High-educated girls, after a few years of training in their jobs, when their emotional intelligence improves, and after marriage, don’t feel as shy about the topic of love, instead becoming rather straightforward.

At this point, they’re all workplace elites.

Handling men becomes a matter of inches.

"Thank you, but I already have a girlfriend."

Li Jingsheng replied with a smile.

Perhaps in this girl’s eyes, being able to sit on equal terms with Director Lian and chat like old friends, he must possess impressive skills.

He’s considered an excellent potential stock.

That’s why she’s willing to proactively offer help.

"Oh dear, it seems like all the outstanding gentlemen these days are taken by their girlfriends! You’re welcome to visit us often, Dr. Li!"

"Haha, that’s a must. With so many beauties here, each one is a beautiful scenery line. If I have time, I’ll definitely come by often."

Li Jingsheng didn’t have any airs about him and never pretended to be aloof.

After chatting with the nurses for a bit to get acquainted, he returned to the office with Lian Tao.

"So, tell me why that patient needed a laryngoscopy just now?"

"Based on the current examination results and the patient’s symptoms, I’ve initially diagnosed the patient with a potential small esophageal tear leading to pneumothorax. With so many complications developing now, it’s very likely a severe thoracic infection has occurred. Despite using numerous antibiotics, the infection remains uncontrolled, and the fever hasn’t subsided, indicating a possible pus cavity in the thoracic cavity, collecting purulent material.

This has already severely threatened the patient’s life.

So I suggest checking the laryngoscope for findings tonight and promptly arranging further treatment plans."

Li Jingsheng outlined his diagnostic conclusion.

He believes the further treatment plan—drug treatment—is probably ineffective now. Surgery is needed.

In terms of safety assessment, performing surgery earlier is definitely beneficial.

Dragging it until the patient’s condition becomes extremely poor, making anesthesiologists hesitant to take the case—surgery then becomes challenging.

Nowadays, well-equipped hospitals pay great attention to CMI scores.

Excellent doctors all want their CMI scores to be high, which greatly enhances reputation, benefits many promotions, evaluations, and entry into certain organizations.

If a patient is admitted but surgery cannot be performed, they definitely won’t be admitted.

The usual advice is for patients to consult other hospitals.

Or advise patients to return to local hospital treatment.

"Tell me your diagnostic thought process for resolving such a difficult case so easily—it’s amazing! I really want to recruit you to help me out."

Lian Tao took off his glasses and rubbed his tired eyes.

"I’ve been so busy lately, and my dark circles never disappear."

Li Jingsheng explained his diagnostic approach one by one to him.

"Old pal, promise me that you’ll come to sit with me whenever you’re free after work. Honestly, I really need experts like you to help me out. I spent over two hours diagnosing this case without major breakthroughs, thinking I’d have to stay up late to search for materials and papers to see if there are similar cases. But you resolved it. Looks like I won’t have to stay up late and damage my liver tonight.

I’ll immediately arrange for a laryngoscopy."

Lian Tao listened to his analysis, his face lighting up with joy.

Another complex case has been cracked.

This feeling is fantastic.

"Helping a brother relieve worries is my duty. If I have time, I’ll definitely come often to learn from you."

Li Jingsheng agreed heartily.

Actually, he’s equally busy.

This is inevitable; as long as a doctor is outstanding, they’ll definitely get busier.

The greater the ability, the heavier the responsibilities.

"Then I’ll head home today. I have to work tomorrow."

Li Jingsheng stood up, preparing to leave.

"Don’t rush, there’s still a case here that hasn’t been diagnosed! Can you help me out again, please?"

Lian Tao clapped his hands together repeatedly, making a pleading gesture.

"You’re more demanding than landlords back in the day, squeezing me for every bit during my rare visit."

Despite this playful complaint, Li Jingsheng took over the patient’s data.

Encountering such complex cases, pooling the wisdom and experience of experts indeed makes breakthroughs easier.