CHAPTER 471: 471 MYSTERIOUS SHADOW

"Perform an abdominal CT scan?" Chen Hongyang asked after a moment of silence.

"Let’s wait. When they return, we’ll check the parents’ mood first. Then, we’ll ask them about the child’s past medical history to see if we can find anything," Liu Banxia said with a bitter smile.

That was a helpless and somewhat timid suggestion, but it was all they could do at the moment.

The wait was somewhat agonizing. When the parents returned with the child, both Liu Banxia’s and Chen Hongyang’s hearts tightened. The parents’ grim expressions were a dangerous sign.

"Things were a bit rushed earlier. Let me introduce Dr. Liu Banxia, our emergency center’s chief resident. He’s been interviewed many times," Chen Hongyang said.

"Let me have the CT films. Then we can talk and see if there’s anything we’ve overlooked in his past medical history," Liu Banxia said.

"Doctor, his temperature is high again," the child’s father said.

"When did this history of respiratory pain and stomach pain begin? Did you take him to the hospital for a check-up then?" Liu Banxia asked.

"He was six. It’s been over two years now," the child’s mother said. "At first, we thought he was just angling for a toy, so we didn’t pay much attention. Later, we took him to the hospital for a check-up. The doctors there did a CT scan and said it was probably nasal sensitivity due to the change of seasons."

"Liu Yiqing, take his temperature again. I’m going to listen to his heart and lungs," Liu Banxia said.

The parents remained silent. Perhaps Chen Hongyang’s earlier introduction of Liu Banxia had an effect, or perhaps it was because Liu Banxia was now examining the child, showing his concern.

"Little man, Uncle is going to press on your tummy in a moment. If it hurts anywhere, tell Uncle, okay?" Liu Banxia said, sitting on the edge of the examination bed.

The little boy nodded, glanced at the IV line in his hand, and frowned.

"Haha, I heard you’re the bravest kid here. You didn’t even cry when you got your shot, right?" Liu Banxia asked with a laugh.

The little boy, who had seemed uneasy, suddenly puffed up with pride. Though he didn’t speak, his eyebrows shot up.

Liu Banxia seized the chance to examine the child’s nostrils. There were no signs of a runny nose. He didn’t dare delay and continued the physical examination while praising the boy.

However, after the examination, Liu Banxia’s brow furrowed even tighter. The heart sounds were normal, but the auscultation of the left lung was slightly different. Yet, such lung sounds shouldn’t cause the child’s current high, persistent fever.

"Is anywhere else uncomfortable? Tell Uncle," Liu Banxia asked.

The boy thought for a moment, then raised his right hand to touch his chest.

"Doctor, have you found out what the problem is?" the child’s mother asked.

"Please don’t worry yet. Let me check further. Liu Yiqing, what’s his temperature?" Liu Banxia said.

"I checked twice. It’s 38.8 degrees Celsius now, a bit lower than before," Liu Yiqing said.

"Then why did he feel so hot when we came back?" the child’s mother asked.

"That might be a difference in perceived temperature, or perhaps the medication is starting to take effect. Please don’t worry for now. Let me look at the CT films again," Liu Banxia explained.

He still suspected a problem with the left lung, as the auscultation findings were slightly abnormal. Of course, such an anomaly could also be present in a healthy person, but it was the only issue they had identified so far.

The child’s abdomen was soft and not tender to palpation. But now he was reporting chest pain. They had to figure this out.

After studying the CT films for a while, Liu Banxia frowned. "Dr. Chen, do you see this area here? Does it look a bit dark to you?"

Hearing this, Chen Hongyang quickly looked at the spot Liu Banxia indicated. It did seem a little dark. But on closer inspection, it didn’t look any different.

Liu Banxia also rubbed his eyes and looked again at the spot he had pointed to. There was a slight shadow. But after staring at it for a moment, the shadow seemed to disappear.

"Liu Yiqing, see if any doctors from cardiology or cardiothoracic surgery are free right now. Invite one to come and help us read these films," Liu Banxia said.

"Doctor, is there a problem with his lungs?" the child’s father asked.

"The area I pointed to earlier, did it look a bit dark to you?" Liu Banxia countered.

"It seemed like it when you pointed it out, but when I looked, I couldn’t see it. I don’t understand these things," the child’s father said.

This was strange. Liu Banxia had reviewed many CT scans, but never one like this. If it were just him, he might have dismissed it as his eyes playing tricks, but the others had sensed it too.

After a short wait, Xu Guosheng from Cardiology arrived.

"Doctor Xu, could you take a look at these films and see if there’s anything wrong?" Liu Banxia asked.

Xu Guosheng examined them carefully, his brow furrowed. "I don’t see any problem."

"Could you look here again? Does it seem slightly darker?" Liu Banxia pointed to the area that had previously caused the visual discrepancy for everyone.

"Huh? You know, it does seem a tiny bit darker. But not very much. Could it be an artifact from when the images were selected?" Xu Guosheng asked after looking for a while.

"If there were multiple spots like this, it might be an issue with image selection, but it’s only this one area," Liu Banxia said. "The child has difficulty breathing and a high fever. After the examination, he also reported chest pain. He has a history of respiratory pain and coughing. His temperature has dropped after taking Tylenol."

"He initially came in for nosebleeds, but those were due to thinning of the nasal mucosa from frequent use of fluticasone propionate. That shouldn’t be related to his main illness."

"Then it really might be a lung problem, but it’s difficult to confirm with the current information," Xu Guosheng said. "Even an MRI would likely show the same as the CT. To get a clear look, we’d have to do a thoracoscopy. There’s no other way."

"Doctor, what kind of procedure is that?" the child’s mother asked anxiously.

"It’s an invasive procedure. We make a small incision in the chest wall and insert an endoscope. This allows us to directly see the condition of the child’s lungs," Liu Banxia explained.

Hearing his words, the child’s parents furrowed their brows. So that was the kind of examination it was.

"Although the child’s symptoms have improved, that’s just the effect of the medication," Liu Banxia said after a moment’s thought. "In my judgment, this condition started affecting him two years ago. Back then, he was very young and couldn’t accurately describe his pain."

"Even now, when he’s uncomfortable, he usually says his stomach hurts. And chest pain, whether in adults or children, is a very dangerous symptom."

"I believe we should perform a thoracoscopic examination on him. A two-year medical history... whatever the illness is, if we delay further, it will definitely worsen."

"This time, it manifested as difficulty breathing and a high fever. The next episode will surely be more severe. And you must have noticed in your daily lives, isn’t he uncomfortable more and more frequently?"

The child’s father looked at his wife, who nodded. "That’s true, especially in the last six months. He often says he’s uncomfortable, so we’ve been using that spray more frequently."

"Dr. Chen, what’s your opinion?" Liu Banxia asked Chen Hongyang.

Chen Hongyang hesitated for a moment, then nodded. "I also lean towards a thoracoscopic examination. It’s the only way to get a direct look."

"The child’s symptoms have been recurring. If we can’t find the root cause of such a condition, it will fully flare up in the future and become uncontrollable."

Even though he wasn’t certain it was a lung issue, he leaned towards Liu Banxia’s and Xu Guosheng’s judgment. A two-year medical history was indeed significant.

"Doctor, will this examination confirm the diagnosis?" the child’s father asked.

Liu Banxia shook his head. "We need to take a look, but we can’t confirm anything yet. CT scanning is advanced, but as you just saw, that faint shadow might be the lesion."

"But the shadow is so faint that when we stare at it, we almost miss it. If I were the only one who saw it this way, I wouldn’t recommend a thoracoscopy."

"However, a thoracoscopy isn’t as daunting as it sounds. It involves making a very small incision in the chest. It’s a type of minimally invasive surgery, which is very common these days, so the impact won’t be very significant."

"Alright, let’s do it. Our child is suffering too much; sometimes he can’t even sleep well at night," the child’s father said, nodding resolutely.

Liu Banxia felt somewhat relieved. Getting parental consent was often the hardest part, especially for an invasive procedure.

"Dr. Chen, please arrange the relevant pre-operative checks for the child. Also, please explain the thoracoscopic exploration procedure to them again in detail. I’m going to contact Chen Xuehai from Cardiothoracic Surgery and ask him to do it," Liu Banxia said.

"Okay, leave it to me," Chen Hongyang nodded decisively.

He was very grateful to Liu Banxia for this. Chen Xuehai was a busy surgeon and wouldn’t normally have time for a thoracoscopic exploration. But Liu Banxia had presented it in such a way, demonstrating his commitment to this child.

"I’ll take these CT films for now and show them to the surgeon who will perform the exploration. He’s a renowned doctor in our hospital, studied in the United States for several years," Liu Banxia said.

"Thank you, Doctor, for taking so much trouble," the child’s mother said quickly.

"We’re all doing this for the child. I have very mixed feelings right now. I hope we find the cause, but I also hope it’s nothing serious," Liu Banxia said sincerely.

After saying this, he took the films and left. He really needed to go talk to Chen Xuehai and persuade him to fit this surgery in.