"Mystery Image" - page 2

There is an Australian ICU web site that has a mystery image (X Ray usually) every couple of months. I have NEVER gotten one right. In their archive on that same page are some incredible films. ... Read More

  1. by   Nursz-R-Awsm
    Okay....I'm with RNed on this one.
    Her description of the landmarks are right on.
    I thought at first glance that it was a collection of three consecutive "slices" getting closer/progressing toward the heart. I will get back to you if I figure out anything more? LOL
  2. by   Jenny P
    Okay, I'll try my guess at this. I think the first image (upper left) is the heart in systole- both ventricles fully contracted. Remember, dark color on an x-ray (and a CT scan) would be air, so the 2 dark shadows in the center heart area of the picture may be either the way the CT scan sees the valve juat as it is moving, or else it's the esophagus and trachea (my guess is it is the former vs. the later). The large dark fields are the nice, clear lungs, with the white "dots" being some cross sections of the pulmonary arteries and clearly visible pulmonary vasculature. Second shot (upper right) is probably either atrial contraction or beginning diastole, with the lower picture being end diastole- just before the ventricles contract.The fuzzyness is probably due to heart movement during the CT. I'm not sure on CT scans, but whenever I have time and my patients' x-rays are laying around, I try to look at them and figure out what I'm looking at. This sharpens my skills I think. But I really don't see that many CTs in my work area.

    Another interesting fact is that when you read a CT scan like this, you must remember you are looking at the body from the feet up, looking towards the head.
  3. by   KellyandtheBoys
    My guess would be some sort of neoplastic disease. It would be a CT of the chest from my rather uneducated guess. So, I'd say it is either a lung CA, a metastatic CA or lymphoma. That would be my guess, anyway.
  4. by   CEN35
    this is clearly a ct of the shest looking for the underneath........upward. there is no oral contrast, which rules out this being a gi issue. there is clearly iv contrast. looking at the pcture...that is clearly the heart, but the wrong angle if you are trying to r/o a disection. the heart is normal in size.........and you actually can identify the aorta on the bottom film.....normal in diamater and appearance. as with kellyandtheboys said.......metastatic disease is one possibility. why? because malignant tumors are highly vascular.....and if it was primary lung can you would see way more than you do. lymphoma is a possiblity.....unfortunately don't have cea's, psa's, alfa fetal proetins, among a good history to know for sure. the one thing that does have me thinking of another possibility, is the vascualr tracking. this does have the possiblity of being an acute problem. in the last couple years, vq scans (which this is not) have taken a dive, and now ct's of the chest are used to r/o pe's. clearly in some vessels the contrast flows and fades out which is normal. however, in the vessels where the contrast builds up........it makes me think of an obstruction....complete in some areas and, incomplete in others. multiple pe's are rare.....but i have seen them.

    in the end i am gonna have to say it like a radiologist. metistatic disease vs multiple pe's......suggest biopsy or follow up ct for changes.

  5. by   P_RN
    The MYSTERY IMAGE has been solved!


    It shows an unusual set of pulmonary AV malformations. The patient suffered a cva during a central line placement.
    Read all about it on the URL above.

    I just LOVE this site. http://www.nepeanicu.org/Scans.htm

    Andrew has done a really good job finding the various images!
  6. by   prn nurse
    What did FES stand for?
  7. by   P_RN
    I think it's Floppy Eyelid Syndrome if you're referring to the pictures on the mystery image page.