The world is big, and there will be any case. To share with you a thrilling case:
It goes back 6 years ago, when a 21-year-old young man went to the doctor because of repeated coughs, chest pain, and fever.
The local hospital doctors admitted him to the hospital, stayed in the hospital several times, did a lot of tests, including chest CT, and initially he was diagnosed with pneumonia, but his condition did not improve significantly after anti-infection treatment.
This is strange, young men cough, fever, chest pain, the most common disease is pneumonia, under normal circumstances with several antibiotics to go down most of the pneumonia can be suppressed, will soon get better, but the patient's situation is not so simple.
If it wasn't pneumonia, what would it be?
Experienced friends immediately think of another disease, yes, tuberculosis.
Tuberculosis is still very common in China, and in recent years there have been about 700,000 new cases of tuberculosis every year.
Tuberculosis is actually also a kind of pneumonia, but the pneumonia caused by mycobacterium tuberculosis is not much the same as that caused by ordinary bacteria, ordinary bacterial pneumonia is acute, the general course of the disease is 1-2 weeks, at most 2-3 weeks, the symptoms are obvious fever, cough, sputum, chest pain, etc., and tuberculosis is often chronic, there may be several months of cough, especially repeated fever, long-term fever, so we generally do not call tuberculosis pneumonia.
The young patient in front of him, repeated coughing, sputum coughing, chest pain, fever, is obviously not ordinary pneumonia.
(First Chest CT)
It should be tuberculosis, the doctor analyzed.
As long as mycobacterium tuberculosis can be found in the patient's sputum, it is certain.
So the patient was left with the first sputum, sent to the test, and did not find acid-fast bacilli. In general, acid-fast bacilli if positive, means that it is almost mycobacterium tuberculosis, and in rare cases, it may also be non-tuberculous mycobacterium.
The first time did not find, so left the second sputum, the third, the fourth time, leave a few more sputum, you can definitely find acid-resistant bacilli, after all, the patient's chest CT looks so much like tuberculosis, and there are long-term repeated fever, cough, cough, chest pain, must be tuberculosis ah.
However, the results disappointed everyone, and there was no trace of acid-resistant bacilli in the sputum left three or four times.
What's going on? The young doctor did not understand.
According to the analysis of the superior physician, there is no acid-resistant bacillus in the sputum, and it cannot be denied the diagnosis of tuberculosis, after all, so many tuberculosis patients, only about 20% of the people who can really find acid-resistant bacteria in sputum, most people can not find it in sputum, because their tuberculosis bacilli are hidden deeper and will not be discharged through the bronchi, so we can't find it, and it is also possible.
What if it wasn't tuberculosis?
What if it's another disease?
Some people even doubt whether it will be a fungal infection caused by AIDS, after all, the patient's left arm still has a tattoo, although it cannot be considered that the tattoo is a bad person, but the young people with tattoos, especially the young people with a dragon tattoo, can always make people think.
Checked, AIDS antibodies are negative, sputum did not find the fungus.
Even the fiber bronchoscopy was done, the mirror was taken directly from the patient's nasal cavity, through the throat, into the airway, deep into the lungs, and the secretions of the diseased tissue were obtained, but the acid-fast bacteria were still not found.
There is no major evidence pointing to tuberculosis.
But the patient gives people the feeling that tuberculosis, long-term low-grade fever, cough, chest pain, recently seems to have a little hemoptysis, sputum with blood, excluding lung cancer, lung fungal infection, ordinary pneumonia, etc., tuberculosis is not running ah, many tuberculosis patients can not find evidence.
What should I do at this time?
Diagnostic anti-TB treatment!
In other words, we are now considering that you are tuberculosis, but the evidence is insufficient, we are ready to give you anti-tuberculosis drugs first, if it works, it is tuberculosis, if it does not work, it is not the possibility of tuberculosis, of course, it may also be drug-resistant tuberculosis.
After listening, the patient seemed to understand and accepted the arrangement. After all, the physical problems make him too uncomfortable, as long as it is not lung cancer, then it is easy to say that although tuberculosis is difficult, it is not a terminal disease, there is always a chance.
So I took anti-tuberculosis drugs and was discharged from the hospital.
After using the drug for a period of time, the effect was not too good, but it was not completely ineffective. The patient was a little anxious in his heart, and tried to contact the other two more powerful hospitals, both went to see, the conclusion is also tuberculosis, let the doctor continue diagnostic anti-tuberculosis treatment.
(Second Chest CT)
The first resistance is 3 years.
During this period, patients still have all kinds of discomfort, bad appetite, not much to eat, feel bloated, fatigue, chest discomfort. Over time, people also become emaciated. At first glance, it is a seriously ill person.
Until 2018, the patient went to a provincial top three hospital, and the doctor felt very strange after seeing the situation, so he arranged to do a chest enhancement CT again and did a three-dimensional reconstruction.
Unexpectedly, this inspection found a big problem.
Discovered a big problem that had never been discovered before.
This chest CT enhancement scan found a linear shadow inside the patient's left chest cavity, and it was quite long. After doing the three-dimensional reconstruction, there is indeed a slender thing in the lungs, which is not simple.
(Third Chest CT)
What the hell is this slender thing? No one knows.
But looking back at the patient's previous chest CT, it should have been at the beginning, but before it was too many lesions around it, it was not clear to see, and now the lesions are less, and it has also done three-dimensional reconstruction, it looks clearer, and it can be recognized as an elongated shadow, which is certainly not the original in the patient's body, nor will it be an ordinary sign of infection, and I have never seen an infection caused by bacteria or viruses so regular (a straight line).
(3D reconstruction)
Immediately after, a lot of bacteria were found in the patient's blood.
The patient had sepsis.
This time, everyone no longer considered tuberculosis.
The question is, why is there such a slender shadow in the lungs, which looks like a toothpick, a large toothpick, such as the bamboo skewers of lamb and beef skewers in the barbecue shop?
Patients remember!
3 years ago, the patient drank too much with a few companions, and fought with another group of people, everyone was drunk, I don't remember why I fought, but also from that fight, I began to have chest pain, cough, fever, I remember when someone took a bamboo stick and stabbed.....
It is likely that he was stabbed in the back by a bamboo stick at that time, and then pierced the skin and directly entered the chest cavity. Since I didn't see the bamboo stick outside the body, I never thought of such a thing.
That's right.
Since the bamboo skewer itself is not easy to develop on CT, because the density is not high enough, if it is an iron skewer, it will be found at the beginning. The reason why the traces of bamboo sticks can be found now should be that there is a circle of inflammation around the bamboo sticks, and the inflammation is developed, and the traces of the bamboo sticks are displayed (Note: Please ask the radiology teacher to correct)
It is also because this bamboo stick has been left in the chest cavity, lungs, so it will lead to repeated infection, inflammation, there is also abscess formation, from the perspective of three-dimensional reconstruction, bamboo stick directly into the left pulmonary artery, a long time will affect the right heart, resulting in the right heart in line with the height, and then the right heart failure. Therefore, patients will have symptoms of gastrointestinal congestion, bad appetite, bloating and so on.
The bitter thing is that the patient has been treated as a tuberculosis patient, and has been insisting on anti-tuberculosis treatment for 3 years.
Of course, the anti-tuberculosis treatment effect of these three years is not good.
Reasoning should be like this, what about the evidence? You can't always cut open your chest and look directly at the naked eye to see if it is a bamboo stick, right?
If you really want to treat it, you can only surgically cut open the chest and remove the bamboo skewer under stable conditions, otherwise the inflammation will always exist. But this operation is not easy.
At this time, the patient is already very weak, the right heart is dysfunctional, and even functional failure is about to occur, and whether he can afford surgery is also one thing. In addition, this bamboo stick directly pierced into the left pulmonary artery, to take it out completely, it is necessary to stitch the pulmonary artery, artery, ah, but not as simple as sewing clothes.
Although the diagnosis is almost clear, the treatment is quite difficult, and the patient is not in a good condition now, and the prognosis is not ideal. More importantly, the patient's economic conditions are not good, and they cannot afford the expensive hospitalization and surgery costs.
He declined further treatment.
When he got home, he couldn't eat anymore, and 1 month later, he died.
It's a shame.
Because the case is more complicated, the time is delayed, there are more things involved, the diagnosis is not 100% certain, there may be a medical lawsuit, so an autopsy was done.
After the autopsy, the results were finally revealed, and as previously speculated, there was a 10cm long bamboo skewer in the patient's left chest cavity, lungs, and blood vessels.
The fever, cough and chest pain that the patient has suffered for so many years are not caused by tuberculosis, nor by lung cancer or other pathogenic microorganisms, but by this bamboo stick that accidentally entered the body because of the fight.
This bamboo stick pierced directly into the left pulmonary artery, so there has been inflammation and infection, because the bamboo stick itself is unclean and comes with pathogenic microorganisms. So repeatedly cause abscesses. Presents similar to tuberculosis.
Why did doctors misdiagnose tuberculosis in the first place? In addition to the symptoms, it is more important that the chest CT performance is also similar. We say that the X-ray chest x-ray of primary tuberculosis shows dumbbell-shaped shadows, have you seen dumbbells? It is the primary lesion, the enlarged hilar lymph nodes, these two look like the two ends of the dumbbell, and the middle drainage lymphangitis is like the iron in the middle of the dumbbell (where the hand is held), as if this:
Then the patient's performance is also in line, because the bamboo skewer, this bamboo skewer simulates the drainage of lymphangitis, there are abscess lesions at both ends, it really looks like primary tuberculosis, so why do several hospitals think it is tuberculosis.
The patient eventually died, and the cause of death should be long-term bamboo skewers left in the body, repeated inflammation, abscesses, thrombosis, resulting in changes in pulmonary arteries, which in turn affected right heart function and led to right heart failure. Eventually, multi-organ failure occurs.
Unexpectedly, in the end, no one could have imagined that it would be a bamboo stick. And it was a bloody case caused by a drunken fight.
(End of this article)
Source of case: Chinese Journal of Medical Sciences (English edition), Pneumonia, multiple pulmonary infarction and lung abscess caused by accidental penetration of bamboo sticks into the chest cavity: a case report misdiagnosed as tuberculosis
Original author: Qu Pengfei and others
This article is a proper compilation based on the original case, if there is infringement, please contact me to delete the article