The Enhanced Doctor-Chapter 631 is not ordinary pneumonia

"Blood pressure 68/105, heart rate 100. Body temperature 38.2, blood oxygen 87." Wei Yuan reported these readings after connecting the patient to the monitor.

"Administer the Seretide inhaler, then provide oxygen. There are signs of enlarged lymph nodes in the neck," Xu Hui stated.

Liu Banxia, on the other hand, was using a stethoscope to listen carefully, his brows knitted in concern.

"Diffuse wheezing in both lungs, normal heart sounds, and abdominal distention. Blood count, blood chemistry, ultrasound, lung CT. How long has the child been like this?" Liu Banxia asked after the auscultation.

"Six days now. It started with a slight cold, and her symptoms worsened yesterday. Last night, she started to feel uncomfortable while sleeping and couldn’t breathe well, which alarmed us," the child’s father explained.

"And her abdomen? It seems swollen. Does she usually tend to have bloating and indigestion?" Liu Banxia asked again.

"It only started to get distended in the past two days. She hasn’t been eating much either, just milk and yogurt," the child’s mother said.

Hearing the mother’s words, Liu Banxia let out a small sigh of relief. The situation wasn’t as dire as I initially feared.

"Do you have any hereditary diseases in your family? Like diabetes or hypertension?" Liu Banxia inquired, nodding.

"No, none of those," the child’s mother clarified.

"Please try not to worry. The child’s blood oxygen level has risen. The medication and oxygen are working. Now, we need to determine if there’s a problem with her lungs," Liu Banxia assured them.

"One of you, please go handle the admission paperwork for the child. This will help us enter her information so we can proceed with the necessary tests. My initial assessment points towards issues with her lungs and bronchial tubes. As for the abdominal distention, we’ll need an ultrasound to assess it."

The child’s parents nodded quickly and hurried to sort out the paperwork.

They didn’t know what "blood oxygen" meant, but they could clearly see that their child’s breathing had become much smoother.

"So, what do you think? Pneumonia?" Liu Banxia asked.

"Pneumonia is more likely, but we can’t ignore the child’s abdominal distention," Xu Hui opined.

"Man... that gave me a scare. Good thing it’s not what I was thinking," Wei Yuan commented.

"We were all on the same page, otherwise, the three of us wouldn’t have gathered here," Liu Banxia affirmed.

"However, I have a very bad feeling about this child’s case. The enlarged lymph nodes, lung involvement, abdominal distention... it all feels like a serious illness."

"Let’s wait for the test results first, then do more targeted tests. It might just be a tumor in the lymphatic system or lungs. We’ll know after the tests," Wei Yuan advised, patting Liu Banxia on the shoulder.

Liu Banxia used to frequently handle emergency patients. This current patient was the first critical case he’d personally managed in a while, and judging by the current situation, it wasn’t looking good.

I hope it’s just simple pneumonia, and the abdominal distention is merely gas, Liu Banxia thought.

Just moments before, the three of them had been discussing teaching and training matters, but this patient’s arrival had captured their full attention.

They were in no mood to continue that discussion; everyone was anxiously awaiting results and speculating on the child’s condition.

Xu Yino wrinkled her nose as she observed. Even I can tell this little patient’s condition is quite serious. All three senior doctors worked on her admission together.

After a moment’s thought, she scurried off to report the latest test results promptly.

"I still feel something isn’t right about the child’s abdominal distention. When I palpated, I didn’t feel an enlarged liver or spleen, and her bowel sounds were normal on auscultation," Liu Banxia said.

Xu Hui gave him a helpless look. "Stop mulling it over for now; let’s wait for the results. Actually, I almost ordered a tumor marker screen, but the parents were already terrified, and the current indications aren’t very clear, so I held off."

Liu Banxia nodded. "Right, let’s wait. I saw Xu Yino rush off, so we should get the results soon. For a moment, I almost thought it was hereditary angioedema, but the symptoms don’t fit."

"There’s no obvious external severe swelling. Even in the early stages of the disease, it shouldn’t be like this. When we attached the electrode pads, I didn’t see anything abnormal. The child also didn’t show any signs of abdominal pain. Hmm... it should just be gas."

Wei Yuan and Xu Hui exchanged helpless glances. It was because Liu Banxia was worried this young patient’s condition would take a turn for the worse.

"Teacher Liu, the abdominal ultrasound shows no abnormalities in the liver, spleen, or kidneys, but the intestines seem somewhat swollen," Xu Yino reported, having returned.

Liu Banxia frowned and nodded. "At least we’ve found a reason for the abdominal swelling. Now we just wait for the CT results."

"Teacher Liu, should I ask the child’s mother about her bowel movements over the last two days?" Xu Yino asked.

Liu Banxia gave her a thumbs-up. "Exactly. Go follow up on the case."

Xu Yino smiled, nodded, and dashed off again.

"These interns can all be considered to have completed their training. Once they become residents and handle more cases, they’ll all be excellent doctors," Wei Yuan said.

"This is also the result of our joint training program. After the CT scan, have Xu Yino thoroughly examine the child’s lymph nodes," Liu Banxia suggested.

"If it weren’t for that, I wouldn’t have asked her to follow this case. She’s had a tough enough day. And don’t think we were just out for a leisurely stroll; dealing with those students’ questions is exhausting too."

"They don’t care if it’s convenient for you to answer; their questions are very pointed. I consider myself articulate, don’t I? Even I have to think carefully before answering their questions."

"Wei Yuan, see? Now that an enlarged liver and spleen are ruled out, his mood has lightened considerably," Xu Hui said with a smile.

"I actually think he’s the one who should really be in pediatrics. He has excellent skills and throws himself into his work completely. He’d definitely lighten the load for the pediatrics department significantly," Wei Yuan remarked.

"You two are my dear brothers, alright? Stop picking on me, will you?" Liu Banxia said helplessly.

"Honestly, I don’t know what’s wrong with me. Logically speaking, I should be able to maintain composure when treating patients by now, right? But seeing this child today, I just got anxious."

"Especially seeing the frantic look on her father’s face, I can’t help but think, if I had a daughter who got sick like this in the middle of the night, how frantic would I be?"

"Don’t even think about that now. You should focus some energy on the teaching and training program," Wei Yuan advised.

"We’ll have to train your future niece well. Maybe I’ll get to personally guide an intern before I retire. I definitely won’t let anyone else snatch that chance."

"How do you know she won’t go into internal medicine?" Xu Hui asked.

"Look at her dad, this famous scalpel. Would she really go into internal medicine?" Wei Yuan retorted.

"Enough, enough! Aren’t you two getting way ahead of yourselves?" Liu Banxia said, exasperated.

Even though I know they’re just trying to lighten the mood, they don’t have to use me as the butt of their jokes.

"Hey, should we call a cardiothoracic surgeon? Is Old Chen on duty today?" Liu Banxia suddenly asked.

"It’s Doctor Wu. Let’s wait a bit and see what the lungs look like first," Xu Hui said.

Liu Banxia nodded; he could only wait patiently.

After waiting for a little longer, Liu Banxia’s phone buzzed with a message. He glanced at it, and his brow furrowed into a deep knot.

"White blood cell count is significantly elevated. Eosinophils are at 10%," Liu Banxia announced. 𝗳𝚛𝗲𝕖𝕨𝕖𝗯𝚗𝚘𝕧𝕖𝗹.𝗰𝗼𝕞

Hearing his words, Wei Yuan and Xu Hui both grew uneasy.

An elevated white blood cell count was normal, given the patient already had some degree of respiratory distress. But such a high percentage of eosinophils was not good news.

Many factors can cause increased eosinophils. Generally, it could be due to allergic diseases like bronchial asthma or hives, parasitic infections, skin diseases, malignant tumors, blood disorders, infectious diseases, and so on.

Considering the patient’s history, it wasn’t bronchial asthma; if it were, it would have manifested before, and her parents would be aware of it.

As for skin diseases, the brief physical exam earlier showed no abnormalities. The remaining potential causes were all rather grim.

After a moment of silence, Liu Banxia said, "Let’s wait for the CT results."

"Maybe we’re just overthinking it. No malignant tumor develops this quickly, right? The parents said her cold symptoms started less than a week ago," Wei Yuan added.

"That’s true. Let’s wait for the results, wait for the results," Liu Banxia nodded.

Sometimes, that’s just how it is. No matter how anxious you are, it’s useless; you have to rely on test results to make a judgment.

After waiting a little longer, Xu Yino returned with the patient.

The three doctors didn’t stay idle, quickly pulling up the patient’s CT images on the computer.

The patient’s lungs showed the tree-in-bud sign. This indicated that her centrilobular bronchioles were filled with mucus, pus, or fluid and had dilated, resembling tree branches just starting to bud in spring.

Continuing to examine the images, they also found diffuse thickening of the bronchial walls in both lungs. Additionally, there was a round nodule, about one centimeter in diameter, with clear borders, in the posterior segment of the right lower lobe.

"The thickened bronchial walls are likely the main cause of the child’s respiratory distress," Liu Banxia stated. "The tree-in-bud sign could indicate pneumonia. It’s hard to determine the nature of the nodule yet, but its clear borders and round shape are relatively good signs."

"My personal recommendation is to perform a bronchoscopy to examine the internal situation, followed by screening for lung cancer and lymphatic tumor markers."

"Perhaps we can postpone the biopsy for now? For the intestinal gas issue, we can start with bowel prep and do a colonoscopy tomorrow? Can we administer levofloxacin to treat the pneumonia first?"

Xu Hui thought for a moment and nodded. Based on the current findings, this approach constituted symptomatic treatment.

The child’s thickened bronchial walls are truly not a good sign. Even if it’s pneumonia, it won’t be an ordinary type; it could very well be fungal or viral.