Chapter 823 - 385: Giant Lymph Node Hyperplasia—No Need to Investigate the Cause for Surgical Treatment (Part 3)

Chapter 823: Chapter 385: Giant Lymph Node Hyperplasia—No Need to Investigate the Cause for Surgical Treatment (Part 3)

Director Xue also detected a deeper meaning in Li Jingsheng’s words.

He believed the bone marrow puncture was somewhat excessive.

He quickly provided an explanation, lest he be underestimated.

Though the orthopedic department’s business is not great, it has not descended into unnecessary tests or excessive examinations.

"Following these clues, I later ordered a chest CT for her, and found a large mass over 4 cm in diameter near the right hilum, with smooth, regular edges, exhibiting lobulated features. Density is uniform and dense."

Director Xue might want to go through all the tests with the patient.

However, the discovery of a large mass near the hilum by the chest CT came as a surprise to Li Jingsheng.

Because the heart and lung sounds he auscultated on the patient were normal.

This illustrates that normal auscultation does not necessarily mean no issues.

This also serves as a reminder for him; he will surely remember this lesson in future diagnoses.

"May I have a look at the film?"

"No problem."

Director Xue directly put the film on the viewing panel.

After Li Jingsheng examined it closely, he breathed a slight sigh of relief.

This female patient from a relatively impoverished background was not seriously unfortunate, after all.

The most feared scenario was a tumor in her lung.

The prognosis for lung cancer is quite poor, indeed. If there is such a large malignant tumor in the lung, it’s almost unimaginable.

The patient’s life expectancy could be less than three months.

"The right main bronchus directly passes through the mass at the right hilum, and I did not detect any obvious anomalies in the heart and lung sounds on auscultation. Given the uniform, dense nature of the mass, with smooth edges, I think it might be an enlarged lymph node."

Li Jingsheng shared his views.

"Our consultation results just now align with Dr. Li’s viewpoint, also considering this to be an enlarged lymph node. We have not yet reached a consensus on the exact nature of the patient’s condition. Dr. Li, could you share your diagnostic opinion?"

After a brief discussion with Li Jingsheng, Director Xue found this young man to be even more impressive than rumored.

His capability is extremely strong.

"Although her hilum presents enlarged lymph nodes, the patient’s symptoms are mild, indicating no respiratory distress. Furthermore, numerous lymph nodes are detected in her inguinal region, so my inclination leans toward Castleman disease."

When the patient’s hilum exhibits masses, and is of the plasma cell variant, fever is likely to occur.

This explains why the patient has had a persistent low fever for eight years.

Though the type of the disease is largely confirmed, the exact cause still requires further investigation and assessment.

Castleman disease, also referred to by several names.

Such as angiofollicular lymph node hyperplasia, multicentric angiofollicular lymphoid hyperplasia, among others.

From these names, it’s evident that it is closely associated with blood vessels.

"Do any of you agree with Dr. Li’s diagnostic opinion?"

Director Xue looked towards the other doctors in the department.

"I support Dr. Li’s diagnostic viewpoint."

"I also believe that the likelihood of Castleman disease is the highest. But what is the specific cause of this disease? Without pinpointing the cause, medication is challenging!"

The heavyweight doctors in the orthopedic department all supported Li Jingsheng’s diagnostic opinion.

Reaching this step, determining the disease is not difficult.

The challenge lies in uncovering the further cause.

"Since everyone agrees it is this disease, then the conclusion can be firmly drawn. Dr. Li, could you assist us not only in confirming the disease type but also in determining the cause?"

Director Xue, being an old hand, skillfully gave Li Jingsheng high praise.

It’s possible they had nearly discussed it before Li Jingsheng arrived.

Yet the true causation of the illness is indeed difficult to find.

"No, no, no, I am merely setting the stage; the teachers here have actually had the answers for some time. As for the cause of the disease, I have looked through some literature. The cause is extremely difficult to ascertain. However, based on her current condition, treatment should not be difficult."

After Li Jingsheng finished speaking, he intentionally paused for a moment.

"Please continue!"

Director Xue waited to hear his insights.

"Purely medication therapy has poor efficacy; it’s very challenging to shrink the mass. For instance, drugs like nitrogen mustard and methotrexate generally do not yield good results after use. I recommend transferring to the cardiothoracic department for surgical treatment."

Li Jingsheng also managed to secure business for the cardiothoracic department.

The orthopedic department lacks hospitalized patients, and when encountered with such a patient, they might be reluctant to let them go.

His earlier pause was also to gauge Director Xue’s stance.

"Surgical treatment should be a last resort, right? If it is possible to determine the cause and apply targeted medication, that would definitely be better."

Director Xue was indeed hesitant to let the patient go.

"Director Xue, you know this patient’s condition. Her financial situation is indeed poor; if she is admitted for a slow investigation of the cause, she might discharge herself forcibly. You are unaware that she initially visited the healthcare station in the city south, where the treatment lasted a week. She was even unwilling to undergo basic tests.

When she came to my clinic for examination, she was tearfully telling me that her in-laws spent a lot on treatment and handling affairs, incurring significant debt still."

Thus, I recommend transferring her directly to the cardiothoracic department, cutting through the confusion, where surgery might actually be her best treatment option."

Li Jingsheng advocated for the most advantageous treatment plan for her.

If Director Xue still disagrees, it would be belittling.

"Just worried that the cardiothoracic department might not necessarily be willing to accept!"

One of the orthopedic doctors remarked.

Everyone understood, reluctant to let go of this patient but unable to speak it clearly.

"I can make a contact; now that the patient’s right lung indeed has a large mass, meeting surgical indications, I believe cardiothoracic should agree to accept."

If unable to perform the operation once received, they might not accept.

Given her condition with explicit surgical indications, more likely they will accept.

"Alright, Dr. Li, please make the contact. If the cardiothoracic department agrees to accept, we will assist the patient in transferring over."

Director Xue made the decision.

It’s unclear why he suddenly relented.

Perhaps he also realized the situation is unavoidable.

Li Jingsheng is closely connected with Director Zhang and others at the cardiothoracic department, frequently performing surgeries together, and such a matter might just involve a phone call.