Wednesday, June 25, 2008

Mystery CT Scan


This a CT scan of a really cool problem we've probably all heard of but never seen. For the sake of argument let's call our patient "Carl Peel"- Dr. Peel's illegitimate son by Bill Clinton. He came in just a few days ago. I'll give everybody some time to guess the diagnosis before giving the whole story. What is wrong with Carl?

35 comments:

  1. Carl has a broken heart and dry skin.

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  2. Carl's liver looks like an octopus.

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  3. Or a jellyfish. Heh, I'm going to the beach house this weekend. Can you tell?

    **his liver enzymes also look like my spam word --gtqql. Not good.**

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  4. I think Carl has liver flukes. It's a fluke, but it happens.

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  5. Could be Gallstone Pancreatitis, or a Splenic Artery Thrombosis, Idiopathic Pneumobilia, Pneumoperitoneum, or a case of Kuru. Dammit this is stealing the Thunder from my "Why I hate Radiologists" post.

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  6. Carl's primary dysfunction is that he's the son of Bill Clinton and Dr. Peel. It has nothing to do with the CT scan - it's all psychiatric.

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  7. Could be an inferior vena caval thrombosis around a Greenfield Filter. Damnit I wanted to be a radiologist.

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  8. I had that fluke shit nailed. Damn.

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  9. ladies. This is Classic "DSB", or Deadly Sperm Buildup. Do NOT fuck with this. Apply lips to Johnson rod, bob forward, then back, repeat.

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  10. No clue, but I just had a CT scan today. This better not be mine!

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  11. good guesses everyone.

    etotheipi, way to take us right to the gutter. classy. very classy.

    radgirl, this is most assuredly not your CT. also, dear radgirl, you may want to check out MDOD professor emeritus frank drackman's post here. i think you will want to chime in.

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  12. I know my professors, and Frank ain't no professor. He's too, um... uninhibited.

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  13. I've rec'd 0.0000 hours of training in reading CT scans, but I'll go biliary atresia.

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  14. He's got a jellyfish in his right upper quadrant.

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  15. Poor carl has thrombosis of his portal system, or possibly just his superior mesenteric vein. I bet he presented with diffuse abd. pain, non localized at first. Had to have a portion of his bowel resected, but is doing ok now, no? Carl was found at workup to have protein C deficiency.

    CAT

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  16. Herpes? Chlamydia? Underdeveloped twin in the abdomen?

    Nice try Etotheipi. Problem is many spouses are worth more dead so this may not be a convincing argument.

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  17. He needs some colonics. If only mainstream medicine would admit that colon cleansing is the answer, you all would be out of business.

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  18. My first thought was his problem was being Deb's son. Then when I looked at the CT my impression was like Frank's.
    Clot around a filter causing portal HTN.

    CardioNP

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  19. ok, here's a stretch:
    -"Carl" is a subtle reference to Caddyshack.
    -Carl Spackler was given the option of swimming in a "pool or the pond", with preference being given to the pond
    -Carl swam in the pond
    -Carl got a liver fluke (eg clonorchis)
    -Carl got cholangiocarcinoma
    -Carl died.
    -Fuck all'y'all

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  20. I have to agree with the thought of an IVC filter.
    Doc In KY

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  21. Is anybody (read:911) going to tell us what is wrong with Carl?

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  22. Looks like the poor chap's got some kind of obstruction in his portal circulation...don't know if it's related to parasites, or alcohol, or some sort of funky hepatitis or what.
    Just a wild guess. In any case, it looks like he's in deep trouble!

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  23. Cat and Anon are probably close. This looks like a broken Greenfield filter with perforation of the inferior vena cava and retroperitoneal hemorrhage as the likely cause of the inflammatory changes inferior to the IVC and/or portal vein..Suspect he was in serious pain.
    I've never seen it happen but supposedly is a complication of placement of the IVC.
    And maybe he did have a clotting disorder, antithrombin deficiency etc as the reason for placement secondary to recurrent PE's..
    ??Correct??

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  24. DING! DING! DING!

    Oldfart proves again that youth and speed are no match for orneriness and cynical thinking.

    70 year old man in excruciating flank pain. Looked like a kidney stone but 70 year old men have something terrible with this kind of pain until proven otherwise.

    the messed-up/broken greenfield filter can be seen on the left hand picture as white wormy things where the 'tentacles' come out of the 'jellfish' (liver).

    the greenfiled is a little metal umbrella that is placed in the inferior vena cava by catheter to catch blood clots travelling to the lungs from the legs.

    this one broke and caused big time bleeding which extends into the retroperitoneum.

    history ruled this case. 70 years old, acute flank pain, recent filter placement. scan was done to confirm what i thought was a ruptured abdominal aortic aneurysm. wrong!

    stat to the OR for repair. not sure how he did. will find out.

    never seen this before. probably never see it again.

    Oldfart!

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  25. Hey, I said it first, the Filter part anyway.

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  26. frank,
    you are correct. you did say it first. somehow your comment escaped my notice, but, to be fair, it's a 'broken greenfield filter' hotshot.

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  27. If this happens to my grandpa, who can I sue? The manufacturer? The surgeon? The hospital? The ER doc who didn't diagnose it immediately? As in 5 minutes before I got to the hospital?

    What were his press ganey scores? Was his pain assessed frequently.

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  28. Great presentation, 911. Talk about wierd!

    I hereby decree that, now and henceforth forever, these radiological findings shall be referred to by all educated healthcare professionals as "abdominal jellyfish sign," which shall be pathoneumonic for "oh shit, the greenfield broke and Carl is bleeding to death! Get the general surgeon! Oh shit, oh shit, oh shit!"

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