Chapter 2915: then translation of title

"This area looks a bit blurry, like a solid‑tissue image." Zhao Wenhua said, "Zheng Lao Ban, you think it's a tumor, right?"

Zhao Wenhua hesitated; it was quite typical imaging data, he had only sought Zheng Lao Ban's glance for some petty thought, yet hearing his tone it seemed not so.

It shows a relatively large mass‑like opacity in the lingula of the lung, associated with lobar collapse, with enlarged lymph nodes below the left hilum and tracheal carina. Zhao Wenhua then examined the film more carefully, ruled out any missed findings, reconfirmed, and nodded.

Upon hearing the word "tumor", the young man beside him felt his legs go weak and panicked.

"It's not a tumor." Zheng Ren said, "Look carefully…… unfortunately there's only one X‑ray film; the image density here differs from that of a tumor, it should be higher. Do you see it resembles bone density a bit?"

Zhao Wenhua stared at the pure‑white image, trying hard to spot any area of differing density.

But he couldn't.

Normally, when encountering a similar patient in the outpatient clinic, Zhao Wenhua should have the patient undergo a plain lung CT scan first, discover the problem, then perform a slice CT three-dimensional reconstruction.

By progressively increasing the intensity of the examination, the problem will be revealed.

Zheng Lao Ban's film‑reading ability is countless times stronger than Zhao Wenhua's, especially his reconstruction ability, which is fully demonstrated here. From the pure‑white image Zheng Ren can spot the problem, but Zhao Wenhua cannot.

"Doctor……"

"Call me Professor Zheng." Zhao Wenhua said somewhat sternly.

"Oh, oh, Professor Zheng, what are you saying? My dad's this isn't lung cancer, is it?" The patient's son asked.

Zheng Ren shook his head and said, "It doesn't resemble lung cancer; combined with your history, I think it's an airway stone."

"Stones? Aren't stones supposed to grow in the kidneys?" The patient's son asked, somewhat dazed.

He only knew about kidney stones; if he thought back carefully he might also recall gallstones. But airway stones were utterly unfamiliar to him, and he simply couldn't understand what Zheng Ren was saying.

"Erm, it's like this." Zheng Ren pointed with his pen at the viewer, "Strictly speaking it should be called bronchial stone, usually occurring on the right side. But your father's case is rather special, located on the left. Bronchial stone disease is also called lithoptysis, referring to calcification or ossification within the bronchial lumen or wall, a relatively rare clinical condition."

"Lithoptysis? Coughing up stones?" The patient's son found it hard to imagine that scene.

"Hmm." Zheng Ren nodded and said, "Many people who cough up stones don't pay attention, nor do they think of stones growing in the airway, so this condition is usually discovered through clinical examination."

"Um…… stones growing in the lungs, can I understand it that way, big…… Professor Zheng?" The patient's son inquired.

"You can say that." Zheng Ren said.

"How does it form? Just grow stones like that?" The patient's son still refused to believe, using his own logic to judge it impossible. Were it not for Zhao Wenhua standing nearby, showing respect and trust toward the young Professor Zheng, he would have already lost his temper.

"There are several sources. First, airway foreign bodies or infected secretions form the stone's core, with peripheral calcium salt deposition gradually forming the stone. Simply put, it's caused by a foreign body entering the respiratory tract; a typical example is a small flying insect sucked into the airway."

"Second, calcification of hilar lymph nodes or intraparenchymal calcified foci eroding the bronchus and entering the bronchial lumen form the stone; this is the most common clinically. But from the image I don't think it's that."

"A third, relatively common possibility is the detachment of tracheal cartilaginous rings……"

"Professor Zheng, are you saying a bone fell off?" The patient's son thought it over with his own understanding, feeling terrified upon reflection.

"You could say that, but it's not what you think." Zheng Ren pointed to a small spot in the left upper lung and said, "Looking here, your father probably had tuberculosis before."

"……" The patient's son looked bewildered.

Nowadays tuberculosis is not what it was over a century ago; many people contract it without noticing, then heal themselves.

Even the patient himself doesn't realize he is still a pulmonary tuberculosis patient.

This is quite common in clinical practice, and Zheng Ren doesn't think it's anything special.

He briefly explained to the patient's family how the tuberculosis bacteria act on tracheal cartilage, causing cartilage detachment and resulting in bronchial stones.

Actually Zheng Ren was mainly speaking for Zhao Wenhua to hear.

"It's too detailed to explain further." Zheng Ren said, "Go home and take your father to a larger nearby hospital."

After a moment's hesitation Zheng Ren continued, "At least a municipal‑level tertiary hospital; better yet go to Sheng Cheng, as this disease is rarely seen even in municipal tertiary hospitals."

The patient's son was about to ask something else, but Zhao Wenhua bumped him, causing him to swallow his remaining words.

"Zheng Lao Ban, I'll handle that side; what examination do you suggest? Bronchoscopy to retrieve the stone?" Zhao Wenhua asked.

"Mm, find a doctor with more experience to perform it. If bronchial stone removal is done improperly, complications can still be serious." Zheng Ren said, "Rest assured, I'm considering it's not lung cancer."

Zheng Ren's final remark reassured the patient's son, who eagerly took the film, thanked Zhao Wenhua, then turned and left.

Zhao Wenhua wanted to call him back, but Zheng Lao Ban, who was reading the film, didn't even say thanks—how could he be so rude?

But his reaction was a bit slow; the patient's son had already walked away happily.

"Professor Zhao, you initially thought it was lung cancer, right?" Zheng Ren asked with a smile.

When facing Zheng Lao Ban, Zhao Wenhua felt drained, having no will to compete; he spoke frankly, "Well, I saw a high‑density shadow with irregular margins and spiculation in the left lower lung inflammatory shadow, and thought it was lung cancer."

"Then why did you have me look at it?" Zheng Ren sat back in his seat, picked up the red thread, and began braiding a red rope.

"Because there had been hemoptysis, blood pooled, and clots could obstruct the bronchus, creating a higher‑density shadow that masks the bronchial stone, making it easy to misdiagnose as lung cancer. I wasn't sure; I originally wanted my classmate to get a CT to check, but then I saw you." Zhao Wenhua laughed.

Zheng Ren braided the red rope without thinking too deeply. Zhao Wenhua's words are always half‑said, half‑hidden—did he see himself? Probably not. He carried the film back from the outpatient clinic; normally one would come looking for him.

Perhaps he was unsure what was going on, which is why he came to have a look. But pondering these little thoughts was tiring; Zheng Ren didn't want to dwell on them, so he continued braiding the red rope.

"Oh, right." Zheng Ren recalled something and told Zhao Wenhua, "Because it's been present for a long time, granulation tissue has proliferated; under bronchoscopy it can easily be mistaken for a neoplasm. At this point a biopsy is needed first to rule out tumor before proceeding with stone removal."

"You haven't confirmed the diagnosis, have you?" Zhao Wenhua asked, somewhat puzzled.

"I just took a glance, had a rough idea, but can't call it a definitive diagnosis. Only pathology can confirm it; reading images is all guesswork." Zheng Ren said.