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Writing article: Wang Yuwei, Jin Di
Although the offices recent business is deserted, I come to the office as usual as usual, and openly open the habitual empty mailbox in habitually open up the habitual empty mailboxEssenceHowever, todays mailbox made me a little unaccustomed, there was a letter in it.
I immediately opened the letter, "Detective, I am a 26 -year -old guy, I suddenly got my heart failure recently, I can only send a letter to the commission, please help, please help, please help, please help, please help, please help, please help, please help.Help me find out the truth ... "
Seeing the entrustment letter, I suddenly had a spirit, slipped into the office, and hung a" out of something out "at the door, sitting onAfter the desk, read the commission letter carefully.
Case express delivery
The main content of the letter
I have been fat since I was a child. Although I have no ability to exercise, I have a good academic performance. I like to reason and often compare myself to Herci Polo, so everyone calls me "Bobo".
I put into my studies most of the time, neglected exercise, and admitted to my favorite university, but the weight has gradually increased, and now I am breathing.I thought at the time that I might be too fat, but my parents were fat, and I couldnt help it.
Later, constipation and skin color spots appeared again, so I wanted to check it out.
The "hypothyroidism" was found first, and the drug treatment effect was not good. Then check that the steroids exceeded the standard, saying that Ku Xin syndrome.
I wondered, why can athletes take steroids to increase muscle weight, and my steroids are more fat and fat?
The next step is to check the more scared. I have a tumor on my pituitary gland, and I have to cut the sword. This is the root cause of a series of diseases such as obesity and weakness.
Two months ago, I had the courage to perform surgery, and took medicine for treatment after surgery, but I still felt weak and became more and more powerful.
To check again, this result made me never expect that it turned out to be heart failure !
I am only 26 years old, why do I get the sick of the elderly ...
I follow the address of the end of the letter, the address of the end of the letter,When he came to Bo Tsais house, he opened the door with Bo Tsais father. Bo Tsai was lying on a large bed, his upper body was cushion, his body was huge, and his mother was anxiously accompanied.I lamented that the weight of this family of three can top my grandparents for three generations, and this hereditary obesity allows him to delay his condition.
I sat next to Bo Tsai, and after a simple introduction, I cut into the topic.
According to the letter, Bobo patients have "pituitary adenoma with central thyroid dysfunction and Ku Xin disease". Two months agoThe maintenance treatment of hydrogenated loose 20mg/day has suffered from breathing difficulties in the past three weeks and was suspected of being heart failure.
"Normal temperature, normal blood pressure, tachycardia, tachyfillation, 97%oxygen saturation. Typical Ku Xin disease, facial acne, full moon face, buffalo back, abdominal type, abdominal typeObesity, obvious stripes in the upper limbs and abdomen.
Bo Tsais mother added: "Bo Tsai has always been a good child, likes reading, learning, never smoking, drinking, not taking drugs, and not traveling. WeIn addition to fat at home, there is no genetic disease.There are no noise, friction sound, edema on both sides of the lower limbs, and melanin sedimentation in the nails.The reason for decay is now only available in medical history and check, and the clues are not sufficient to form strong evidence. I need your cooperation.> Limited to the symptoms of Bobos obesity and the symptoms of asthma, the process of collecting clues is not smooth. After some efforts, the following clues are collected, which is enough for me to reason.
· Clues Summary ·
Bremist: Heart hypertrophic, pulmonary vascular, blood vessels blood vesselsCerebration, prompt .
Bremist CT enhanced scan: pulmonary blood vessel congestion, edema, lesions of left lung wildlife, bilateral thoracic effusionThe upper left lung biopsy shows non -specific inflammation and fibrosis (Figure 1).
Merid -with ultrasound heart -moving map: double room, large left ventricular, moderate valve return flow, three -pointed valve moderate return flow, the thickness of the ventricle is normal, severe left ventricular dysfunctionWith the loss of pervasor exercise, the left ventricular ejection score is severely reduced (Figure 2).
Energy -esophageal ultrasonic diagram: There are no consequences, thrombosis or oval holes.
Heart MRI: EF 18%, the left ventricular diastolic inner diameter is 69mm, the left room capacity of the last period of the diastolic is 298ml (normal 52-195ml), and the end of the left room with contractionThe capacity of 245ml (normal 13-72ml), evidence of no myocardial fibrosis or scar (Figure 3).
Alarm: Left ventricular angiography found severe left ventricular dysfunction. No Not complete.
ECG: sinus heart rhythm.
Breeding and immunological indicators are negative.
Figure 3 Heart MRI
All the clues of the case are all gathered. You might as well stop and reason yourself?The mystery is below ~
In -depth analysisFacing the vision of the audience, I started myself myself myselfReasoning: "Dont be nervous, better than you think."
Bobo asked weakly: "Heart failure?"
I said: "Yes, chest, CT prompts congestive heart failure, color Doppler ultrasound and MRI prompt EF reduction, and heart failure can be certain. As I said before, heart failure is just the only thing I said before, heart failure is just the only heart failure.As a result, what we want to find is the reason.The ventricular expansion and the diffuse exercise are reduced. This change is like dilated cardiomyopathy, but the dilated cardiomyopathy is used as primary myocardial disease. Before diagnosis, all secondary myocardial dilatation must be excluded.Inferences "I listed a list:
Elimination Diagnosis ·
1. Crown -shaped shapeThe arteries have no lesions, eliminating ischemic myocardial disease.
2. The pathogen detection is negative, and .
3. There is no corn balloon -like swelling, no stress factors, excluding Takatsubo type cardiomyopathy.
4. There is no family history and electrocardiogram change to exclude genetic myocardial disease and channel disease.
5. No history of drinking, exclude alcoholic myocardial disease.
6. The immunology indicators are negative, excluding autoimmune diseases such as lupus myocarditis.
7. CT results of the lungs can exclude nodule disease.
8.
"Its excluded." Bo Tsais voice was a little disappointed.
"No, there is another possibility!"
Dear readers, do you know what the final diagnosis is?
Long press to identify below QR code or click at the end of the text Read the original text link to open the first article to view the answer ~
Responsible editor: Silver
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