Chapter 2236: 2159 Good Intentions, Bad Outcome (Alliance Leader Muwu VIP Extra Chapter 1)

"Does menstruation affect pneumothorax, or is pneumothorax related to menstruation?" Su Yun looked at Zheng Ren, puzzled.

Zheng Renye was also dazed.

Menstrual pneumothorax is indeed a thing, though it's mostly related to endometriosis. But if it's endometriosis…

Zheng Ren froze for a moment—could it be menstrual pneumothorax?!

This disease is so rare that Zheng Ren hadn't even considered it.

"Boss, if it's endometriosis, it would mainly cause right-sided pneumothorax, occurring during menstruation, but… Old Shao, the patient has had seven surgeries—how many times on each side?" Su Yun asked.

"Left side four times, right side three times." Shao Jinghe replied immediately.

"That probably isn't it." Su Yun frowned, speaking softly.

He lacked confidence, subconsciously hesitating to say it was spontaneous pneumothorax caused by endometriosis.

Zheng Ren suddenly stood up and went back to the viewbox, looking at the images.

Shao Jinghe was dumbfounded, staring blankly at Fang Lin, at a loss.

Fang Lin had never encountered this disease either; although he knew about menstrual pneumothorax, it wouldn't even be on the exam.

If any examiner put this on a test, they'd probably get pneumothorax from being hit.

"Endometrial tissue migrates to the pleura and lung surface, where it grows; when menstruation occurs, it sheds. Because the pleura is thin, it's easily damaged, allowing air from the lungs to enter the pleural cavity, forming a pneumothorax and causing symptoms." Zheng Ren said while thinking.

It was like talking to himself, yet also like conversing with some unseen existence in the dark.

"The diaphragm is fine."

"Hmm, not like a diaphragm problem." Zheng Ren looked at the film, "Generally, menstrual pneumothorax is accompanied by diaphragmatic damage…"

After saying that, he rested his chin on his hand and asked, "Old Shao, if I'm not mistaken, you just said that each time the patient had pneumothorax it was during menstruation, and the periods were also long with heavy flow, right?"

Shao Jinghe nodded repeatedly.

Although he had no idea what this little Boss Zheng was thinking, he could still answer the most basic question.

"Uh…" Fang Lin wasn't looking at the film but at Zheng Lao Ban, somewhat speechless.

"Diagnosing menstrual pneumothorax." Zheng Ren said firmly, "There are four diagnostic criteria."

"…" Fang Lin stared at Zheng Lao Ban in disbelief, wondering if he'd misheard.

"First, spontaneous rupture of pulmonary bullae."

"Second, uneven uterine contractions during menstruation push gas into the uterine cavity, through the fallopian tubes into the peritoneal cavity; at this point, displaced endometrial tissue blocking the diaphragmatic micro-pores sheds, opening the diaphragmatic channel, allowing gas to enter the thoracic cavity and cause disease."

"Third, shedding of displaced endometrial tissue on the visceral pleura causes lung leakage."

"Fourth, prostaglandin-induced bronchiolar constriction or a one-way valve mechanism from bronchiolar endometrial displacement causing alveolar rupture."

Zheng Ren then began listing one, two, three, four, five; not only Shao Jinghe but even Fang Lin listened in a fog.

"With endometrial implants, diagnosing menstrual pneumothorax meets criteria one and three." Zheng Ren said.

"But…" Shao Jinghe wanted to say something, but ultimately didn't.

"The diaphragm has a problem." Su Yun added, "A tiny tear only produces a small gap when abdominal pressure rises, causing endometrial tissue to become displaced again."

"Again…"

"It travels further, landing directly on the lung. Finally, during menstruation it erodes and breaks the visceral pleura, resulting in recurrent spontaneous pneumothorax."

"Hmm." Zheng Ren nodded, "Old Shao, did you observe the diaphragm during surgery?"

"No…"

Shao Jinghe was bewildered—who would check the diaphragm during a pneumothorax operation if there's nothing wrong?

"Well, during surgery, with single-lung ventilation, carefully check the diaphragm's position; there's probably a small tear. Forget it, better to use laparoscopy to increase pressure—then high pressure lets you see gas entering the thoracic cavity."

"Zheng Lao Ban, Yun Ge'er, shall we go up and take a look?" Fang Lin felt uncertain.

"You make it sound like you don't have a team-leading professor." Su Yun blurted out.

"That's what you say, but not letting him go up is absolutely impossible. With such a rare menstrual pneumothorax, if we don't go take a look, Su Yun will have to fight Fang Lin to the death."

"The patient's fasting time is fine; we've signed up for surgery. There's still half an hour of prep before the operation, so Zheng Ren and Su Yun went straight to the operating room."

"Boss, the diaphragm's muscle is usually well-developed and rarely problematic. Is it a congenital issue?" Su Yun asked.

"It's possible; we'll know once we go up." Zheng Ren said, "Repair the diaphragm, and postoperatively we should administer chorionic gonadotropin‑releasing hormone therapy; it should improve quickly."

Su Yun suddenly thought of something; he looked at Shao Jinghe and asked, "In previous surgeries, was postoperative pathology done?"

"…"

One question left Shao Jinghe dumbfounded.

As a rule, all excised tissue should be sent for pathology—for example, the appendix; out of a thousand, maybe one or two show malignant change.

Because pathology takes long and is costly for some families, many refuse the test.

Doctors, especially those at lower‑level hospitals, rarely force patients to undergo pathology. Yet for patients coming to 912, they never tell the family; doing pathology post‑op is taken for granted.

This is the difference between a small local hospital and a top‑tier tertiary hospital in the capital.

This patient has spontaneous pneumothorax; the diagnosis is clear, and intraoperatively the resected pulmonary bullae showed basically no problems.

At least Su Yun has never seen such a thing.

I'd guess Dr. Shao Jinghe is thinking the same way—looking at him, he probably didn't do pathology.

Sure enough, Shao Jinghe said sheepishly, "We didn't do it."

"Old Shao, your work is too careless." Su Yun said disparagingly, "Even if you'd done it just once, this wouldn't have happened. You…"

"Yun Ge'er, it's not like that." Shao Jinghe was on the verge of tears, hurrying to say, "The patient's family isn't well‑off, so I didn't dare use titanium clips during surgery—everything was hand‑sutured. Even if pathology were done, the report would just note changes in the bullae; I think it's meaningless."

Zheng Ren sighed and shook his head slightly.

Testing is like this—normally the chance of error is low. But once a problem does arise, like the current situation, it can lead to misdiagnosis or missed diagnosis.

This is exactly the classic case of good intentions leading to bad outcomes.

Having said that, even if Shao Jinghe had done the pathology and sent the specimen to the lab, the doctors there would probably go crazy.

The pathological examination of lung bullae matched the microscopic appearance of endometrium; the local Hospital had nobody who dared to diagnose.

When the time comes, taking the pathological slides to the higher-level Hospital for another diagnosis is still a hassle.

If a grassroots Hospital can correctly diagnose and treat common diseases, that's already quite good.

As for rare diseases, you might not see a case in ten or twenty years; even if you had mastered a whole set of dragon-slaying skills, it would be utterly useless.

……

……

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