Chapter 2211: 2134 Imaging and logic contradict—how to judge

2134 Imaging and logic contradict—how to judge? (Alliance Leader: fate of beginning, fate of ending, fate of self, added chapter 4)

Looking at the previous films, the patient's diagnosis is clear: primary liver cancer.

There is a 3×4 cm lesion on the liver, while the gallbladder is intact—let alone stones, not even a bit of roughness on the gallbladder wall.

Moreover, what Zhao Wenhua inserted was not one previous film, but two.

The first is a pre‑operative film, with no iodized oil in the lesion. The second is a post‑embolization film; judging by the date, the procedure was done a few days ago.

In the most recent film, the tumor's interior is necrotic, and the needle tract is still visible—this suggests radiofrequency ablation was performed after embolization.

"It shouldn't be gallstones." Zheng Ren said firmly.

After looking at the films, he knew where Zhao Wenhua's dilemma lay.

Zhao Wenhua nodded repeatedly, "Boss Zheng, there were no gallstones before the operation. In just a few days, it's impossible for a large amount of sludge‑like gallstones to appear. That's the usual logical judgment, yet the imaging shows them anyway."

Saying that, he sighed helplessly.

Sometimes imaging and logical judgment differ; the vast majority of doctors take the objective imaging as the final basis.

After all, imaging exists objectively—otherwise what's the point of imaging the patient? Meanwhile, logical thinking is often limited by the doctor's own quality and level, and even related to environment, mood, and so on.

But at Zhao Wenhua's level, objective imaging is only one reference standard; he won't blindly trust any objective imaging.

The higher a doctor's level, the more issues they consider.

Every problem that logic cannot resolve may give rise to a very rare situation, worsening the patient's condition and even leading to death.

Even if the film shows a very typical imaging diagnosis, one must still think it through.

This is also why Zhao Wenhua stared blankly at the CT scan whose diagnosis seemed "clear."

Because he could only sense that something was wrong, yet he couldn't overturn the gallstone diagnosis. The two contradict each other, leaving one with no recourse.

"What about other lab tests?" Zheng Ren asked.

Lin Yuan sat to the side, writing the medical record. She was a bit drowsy, but hearing Boss Zheng say that, she perked up.

That's the tone of a senior physician speaking; as the lowest‑ranking doctor in Boss Zheng's medical team, I certainly had to run over and hand him the other lab tests he needed.

It was like that at Harvard, and back at 912 it's the same.

However, the next second Lin Yuan was stunned.

She saw one of the team‑leading professors of the 912 Intervention Department, Zhao Wenhua, slightly bending his waist, rushing to the computer, and swiftly printing out all the patient's examination reports.

The printer hummed, spitting out page after page of A4 paper.

Lin Yuan looked at Zhao Wenhua in surprise; seeing his anxious face, every time the printer spat out a report sheet he grabbed it directly.

As for what!

Although Boss Zheng usually doesn't like to joke, tapping the radial styloid with hemostatic forceps on the operating table is painful, yet he is usually quite amiable.

Lin Yuan somewhat didn't understand why Professor Zhao Wenhua's demeanor was so humble—he practically seemed more like a junior doctor than she did.

"Boss Zheng, look." Zhao Wenhua immediately took the problematic test report in hand, blew on it to let the heat from the printer on the A4 paper dissipate a bit.

Sure enough, the patient's white blood cell count was high, urinary amylase was also high, and serum lipase had risen somewhat.

Blood calcium decreased, blood glucose increased……

Zhao Wenhua is experienced; all the necessary tests have been done, and Zheng Ren has nothing to criticize.

"Does the patient have a history of diabetes?" Zheng Ren asked.

"No." Zhao Wenhua replied immediately.

No diabetes history, yet blood glucose is up and calcium down—this is one of the typical lab findings of acute pancreatitis.

Could it be a postoperative stress reaction causing cholecystitis and acute pancreatitis? Zheng Ren flipped through the test sheet, thinking.

Although he thought that, he did not draw a simple, rash conclusion.

The patient's lab results and imaging studies point clearly to acute gallstones and acute pancreatitis.

But!

Still, there's no way to explain where all that sludge‑like stone came from.

If it were the rough‑wall type of cholecystitis, Zheng Ren would probably have given up pondering it by now. But the gallbladder went from nothing to having a large amount of sludge‑like stones in just a few days—no matter how you look at it, it's wrong.

Moreover, the patient is postoperative; even if their usual diet is irregular, at this moment the family's care is meticulous—if they can eat, they settle down to eat.

Strange.

Zhao Wenhua looked at Zheng Ren, full of anticipation.

"Tell me about the patient's condition." Zheng Ren stood at the film‑viewing spot, arms crossed, chin resting on his hands, seriously examining the films, and said calmly.

The junior doctor from Zhao Wenhua's team was about to speak when Zhao Wenhua cut him off.

"This is how it is, Boss Zheng." Zhao Wenhua, like a junior doctor, began to report the case history.

"The patient came to our hospital a week ago for an outpatient visit; the preliminary diagnosis was liver cancer, so I admitted him after my clinic. Three days ago we performed liver cancer transarterial embolization plus radiofrequency ablation. There is one film, which is the image left after the embolization."

Zheng Ren nodded, indicating he understood.

"Post‑operatively the patient's recovery was fairly good, but early this morning he suddenly complained of severe abdominal pain; an urgent CT revealed gallstones and pancreatitis. After consultation, the hepatobiliary surgery diagnosis was the same, recommending symptomatic treatment."

"But I looked at the films and think there's a problem." Zhao Wenhua said cautiously, "The patient's condition isn't good, and the pain hasn't been relieved."

"Have you given analgesics?"

"I've held back on giving them; some things still aren't clear."

Zheng Ren nodded.

Giving painkillers without understanding would be courting death.

No! Just now, looking at the lab report, I felt something was off, but I glanced over it and didn't pay attention.

Zheng Ren, doubtful, picked up the lab report again and examined it item by item.

Soon he found the problem: the patient's CBC shows high white blood cells, which can serve as one piece of supporting evidence for cholecystitis or acute pancreatitis.

But the patient's hemoglobin has dropped to 76 g/L, whereas pre‑operatively it was normal.

"Anemia? Professor Zhao, how are you considering this?" Zheng Ren asked.

Zhao Wenhua shook their head, somewhat bewildered.

Whether it's radiofrequency ablation or interventional embolization Shou Bing, neither will cause anemia.

Let's not talk about interventional embolization, a pinhole in the femoral artery of the thigh, then the guidewire and catheter enter, performing embolization treatment inside the blood vessel. Bleeding complications rarely occur, because embolization itself is one of the hemostatic treatments.

As for radiofrequency ablation, the radiofrequency needle is not thick; it goes into the liver, and after ablation, when withdrawing it, to avoid migration of the needle tract, the radiofrequency needle must be heated.

While killing tumor cells, the puncture needle tract will also be 'scalded' once; even if there is capillary bleeding, it will be as if it had been electrocauterized, and the bleeding will stop.

Before surgery there was no anemia; the first postoperative follow-up also showed none; starting from early this morning, progressive anemia has appeared.

This is a particularly suspicious point.

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