Doctor Song, are you married?

Chapter 63 63. Diagnostic gold standard

"Doctor Huang, do you have a blood pressure monitor here?" Song Qi asked eagerly as soon as he entered the B-ultrasound room.

"Yes, what's the matter?" Dr. Huang glanced at the patient in the wheelchair. He looked fine, and it didn't look like there was an accident.

No surprises, what blood pressure?

"I'll take his blood pressure first." Song Qi didn't bother to explain, took the sphygmomanometer and measured it for him. After measuring the right side, he measured the left side.

After the measurement, he felt worried, and stretched out his hands to count the pulses on both sides of the radial artery.

After some operations, Song Qi was basically confident, and then turned to Dr. Huang, "Doctor Huang, can you do another B-ultrasound for this patient?"

"Do it again?" Dr. Huang thought to himself that after working for so many years, this B-ultrasound is the most serious and careful, why is he still not satisfied?
"I'll do a beam arm decompression-compression test later, and then look at the frequency spectrum at the moment of deflation." Song Qi explained.

"Brace arm decompression-compression test? What are you thinking about?" Dr. Huang also thought of a very awkward syndrome in his mind, but he couldn't think of it all at once.

"Subclavian artery steal syndrome." Song Qi quickly reminded her.

"That's right, that's the disease. I've been working for so many years, and I remember encountering it once or twice, and it was more than ten years ago." Dr. Huang said, his affection for Song Qi escalated again, with such a comprehensive knowledge at a young age, the future is boundless!

Song Qi was in charge of pressurizing and decompressing the cuff on the patient's left upper arm, while Dr. Huang was using B-ultrasound to detect changes in arterial hemodynamics.

"Oh, it's really typical." Dr. Huang pointed to the frequency spectrum of the left vertebral artery for Song Qi to look at.

Song Qi didn't know much about imaging, but with Dr. Huang's explanation, he roughly saw the double-stage vertebral artery reflux.

"However, Xiao Song, although the image spectrum is relatively typical, it is better to let the patient do a DSA. Being responsible to the patient is also considered to protect oneself." Dr. Huang said, typed a left subclavian artery steal syndrome on the patient's B-ultrasound diagnosis report, and then typed "?" followed by a sentence: Please do further examination in combination with the clinic.

There are dozens of "?", which means that the diagnosis cannot be made. Song Qi also knows that the gold standard for diagnosing subclavian steal syndrome is DSA, but considering the price of 3000-5000, Song Qi really can't open his mouth.

otherwise?
Song Qi remembered the system's rewards.And began to secretly start calling the system.

[Do you use systemic adjuvant therapy (diagnosis)? 】

Song Qi clicked to confirm.

The system interface is automatically called out.

A clear angiographic image flickered in front of Song Qi's eyes, even clearer than what he saw during his internship at the People's Hospital.

The origin of the left subclavian artery overlaps with other blood vessel positions in conventional position angiography, which cannot be fully visualized.The system repeatedly adjusted the imaging position, and finally found that the left subclavian artery was subtotal occluded, and the blood flow of the left subclavian artery was "reversely supplied" by the left vertebral artery.

Sure enough, it was left subclavian artery stenosis, and it was a serious type.

"Doctor, what is my disease?" the patient asked again.

Song Qi gained confidence now, "Let's put it this way, it's like a blood thief living in your body."

"Blood thief? Doctor, what is going on? Don't scare me!" The patient was terrified when he heard this strange statement.

"To put it simply, your arm 'stealed' the blood in your brain. Just now, I saw through the B-ultrasound that your left subclavian artery was severely narrowed before it gave off the vertebral artery, and the blood flow in the subclavian artery increased. It also produced a 'siphon effect', turning into a 'greasy rat', allowing the blood flow from the vertebral artery to retrograde into the subclavian artery, causing dizziness and fainting due to insufficient blood supply to the brain. Explain to the patient in as simple a language as possible.

The patient understood now, but also became nervous, "Doctor, can this strange disease of mine be cured?"

"Can be cured is able to be cured" Song Qi did not continue.

Subclavian artery steal syndrome is a disease that can be completely cured. As long as a stent is implanted in the subclavian artery, the arterial lumen can be rebuilt.However, this fee is at least 5 yuan!

"It will be cured, doctor, thank you so much. If it can be cured, my wife will no longer have to worry about it all day long." The man looked hopeful, and Song Qi really couldn't bear to extinguish his flame of hope.

When he returned to the expert clinic, Wang Jian hadn't left yet. He must have been waiting for the patient's B-ultrasound results with a special mood, and Shan Weihao happened to take care of a patient, and the clinic was in a free period.

"Director, after a preliminary judgment, the patient should have left subclavian artery steal syndrome." Song Qi walked up to Shan Weihao with the B-ultrasound sheet.

As soon as this awkward and strange disease name was uttered, it immediately attracted the attention of both of them.

"What?" Shan Weihaoming thought he heard it wrong.

This disease is not common, and it is not so easy to diagnose. He dares to draw a conclusion with a B-ultrasound?

"Left subclavian artery steal syndrome." Song Qi repeated.

"For such a complicated case, it's too hasty for you to do a B-ultrasound to make a diagnosis, right?" Shan Weihao said, taking the B-ultrasound report handed over by Song Qi.I thought to myself, after all, I am still too young, and I am a bit impetuous in doing things. It seems that I need to polish it in the future.

"The blood pressure on the left side of the patient could not be measured, and the body surface temperature of the left arm was significantly lower than that on the right side. Also, the pulse pressure difference between the left and right sides was 20. The first B-ultrasound showed stenosis of the subclavian artery and vertebral artery regurgitation. The instantaneous blood flow spectrum after the cuff compression-decompression test indicated double-stage vertebral artery regurgitation. In addition, according to the patient's self-report, several syncope occurred when the arm was raised. Therefore, clinical manifestations and imaging diagnosis can basically be diagnosed as left clavicle steal syndrome."

Song Qi's thinking was clear and logical, and Shan Weihao really didn't know how to refute him for a moment.

However, how could such a rare case be diagnosed so easily in a hospital of the level of Chinese and Western medicine in the district?At least you have to consult with various departments, right?

"Xiao Song, this is just your reasoning. Don't you know what is the gold standard for the diagnosis of subclavian artery steal disease? Our clinical practice relies not only on theoretical knowledge, but also on absolutely reliable auxiliary examinations. Besides, hospitals of our level are not qualified to diagnose this disease, right?" Wang Jian leaned over to look at the B-ultrasound report, and smiled instantly.He laughed at Song Qi's youth and frivolity, and also laughed at his overreaching.

(End of this chapter)