Chapter 797: with translation of chapter title

On the image, the patient has no spleen.

Remaining in place, a scar tissue can be vaguely seen.

"Hmm, probably a splenectomy was done." Zheng Ren then asked: "Who is the patient to you?"

"She is my lover." The middle-aged man answered cautiously.

"How many years ago was the splenectomy done?" Zheng Ren asked.

"Twenty-two years ago, there was a car accident, and then a splenectomy was performed." The man immediately replied.

Generally, when doctors look at images, the first question they ask is about splenectomy, not about situs inversus; there's nothing special about it.

Zheng Ren continued to rest his chin on his hand while looking; the professor stood at his rear side, also intently reading the images.

It's been a long time since I've looked at images together with the boss; this feeling is really great.

A few minutes later, the professor said: "Boss, this liver cancer seems a bit strange; I feel it might not be."

"Hmm, it is a bit strange, but it's not certain it's not liver cancer." Zheng Ren rested his chin, looked at the image, and said: "I highly suspect it's ectopic spleen implantation, not liver cancer."

"What?" Professor Rudolf Wagner exclaimed in surprise, "Boss, how did you figure that out? Is it because this area looks a bit bald and reversed?"

Saying that, the professor pointed to a location on the image where the signal was abnormal.

"Not entirely; there's just a slight signal abnormality there. Fugui'er, have you noticed that the patient underwent an interventional embolization?"

"I noticed." Professor Rudolf Wagner, hearing Zheng Ren mention embolization, seemed to recall something and stared intently at several frames of the image.

Zheng Ren did not continue explaining; for the professor's image-reading level, saying this much was already enough.

The middle-aged man became puzzled.

Logically, a swindler would exaggerate the illness to make it sound worse, so why would this young "doctor" say it's not liver cancer?

Ectopic what implantation?

Is it a metastasis?

Full of doubts, his ears perked up, wanting to listen to the conversation between Zheng Ren and Professor Rudolf Wagner.

But then they both fell silent, not saying a word, and began to "read faces" of the image.

A few minutes later, the professor clenched his right hand into a fist and struck his left palm, making a "pa" sound. This gesture, the professor and Su Yun learned to perfection.

"Boss, I've figured it out! It's definitely ectopic spleen implantation!" Professor Rudolf Wagner said happily.

"Hmm, the diagnosis is relatively clear. Especially after undergoing an interventional embolization treatment, it can basically be confirmed." Zheng Ren said.

After saying that, he took the film down, put it into the film bag, and said: "Go find Professor Yang; I'll write the diagnosis on paper shortly. For this condition, Professor Yang's side performing a resection Shou Bing, postoperative pathological diagnosis, is sufficient."

Saying that, Zheng Ren found a discarded A4 sheet, crossed out a few strokes on the front side to indicate it was void, then wrote his diagnosis and surgical suggestions on the back.

The patient's family member was stunned.

His mind had already sketched out many possible things Zheng Ren might say, and he had made contingency plans for each.

If he were a swindler, what to do about it, he had it figured out in his mind.

However, this young "swindler" actually sent himself back to the General Surgery Department.

Could it be that I guessed wrong?

The middle-aged man held the paper, carefully examined the characters, and became doubtful.

"Go ahead, I heard Professor Yang say that your lover has long had upper abdominal pain, which is due to spleen implantation causing liver congestion. It's not a big deal; removal will be fine." Zheng Ren said, taking out his phone.

He first left a note on Professor Yang's phone, then dialed out.

"Professor Yang, I've finished looking at the patient's images."

"Uh..."

"Okay, okay. Brother Yang, the images suggest ectopic spleen implantation, not liver cancer."

"Right, right, your judgment is correct. If there are beds available, admit the patient for a resection Shou Bing; pathology... during the operation, cutting open will show it's spleen tissue."

"Oh, okay, the patient's family is with me. I'll bring them up..."

"Alright, then I'll wait for you."

After saying that, Zheng Ren hung up the phone.

"Professor Yang... Brother Yang said he'll come down shortly; wait a bit so we don't miss him." Zheng Ren said to the patient's family.

The patient's family member looked completely bewildered; the developments had totally gone beyond his expectations.

Soon, Professor Yang arrived at the Intervention Department wearing an isolation gown and a sterile cap, hurrying.

"Zheng Lao Ban, I just feel it's not liver cancer." After entering, Professor Yang hurriedly said.

It seems he just stepped down from his post not long ago, hasn't even had time to change clothes; he might have come down during a surgical break, squeezing in time.

"There's a ninety percent chance it's ectopic spleen implantation." Zheng Ren nodded.

For such a matter, Zheng Ren cannot and dare not guarantee a hundred percent. If the intraoperative frozen section turns out malignant, there would be no way to explain it.

Without a pathological gold standard, even the diagnosis of Big Pig Trotter makes Zheng Ren doubtful.

"Zheng Lao Ban, your level is truly high." Professor Yang praised: "Please explain to me how you figured it out."

Zheng Ren felt a bit strange; after a single autologous liver transplant, Professor Yang is like this?

However, seeing Professor Yang intently examining the images, seemingly speaking his mind, he didn't think much and just smiled.

"You're not involved in intervention, so you're not familiar with interventional images." Zheng Ren said: "The patient underwent an interventional embolization; look here, on the image after embolization with iodized oil deposition, only the embolized necrotic foci exist, while typical liver cancer lesions are not shown in the image."

Few liver cancers present such an image. Combined with the patient's history of intermittent abdominal pain for many years and a splenectomy twenty-two years ago, I judge that the possibility of ectopic spleen implantation is relatively high.

Professor Yang looked at the image; Zheng Ren's words resolved several of his doubts, but the reasons were not very sufficient.

Zheng Ren's words can probably rule out liver cancer, but cannot rule out spleen implantation.

"Zheng Lao Ban, if it's spleen implantation..."

"Preoperative 64-slice CT enhancement shows the lesion exhibiting uniform enhancement in the arterial phase and mild enhancement in the venous phase. Angiography shows hepatic artery branches supplying this round hypervascular mass. At this point suspecting liver cancer is not wrong." Zheng Ren said, picking out another film from the film bag.

"Postoperative review, the arterial phase enhancement on Nuclear Magnetic Resonance is not obvious, but the metastatic lesion on the abdominal wall shows opposite characteristics." Zheng Ren said: "Because the vessels in the abdominal wall lesion are small and have not received embolization treatment, this resembles the post-embolization imaging of splenomegaly."

Interventional embolization treatment for splenomegaly and liver cirrhosis can effectively increase white blood cell and platelet counts.

Zheng Ren, although he hasn't done it before, Interventional surgery is near the pinnacle; this kind of "minor Shou Bing" is as familiar as the back of his hand.

"So, I'm fairly certain the local doctor performed a splenic embolization Shou Bing." Zheng Ren said with a smile.