aka Radiological Oddity 020.1
Unfortunately I can’t see ACEM accepting this image as a VAQ for a future Fellowship exam.
Not to worry, UCEM will!
So, LITFLers, here is yet another chance for you to become an esteemed Fellow of the Utopian College of Emergency for Medicine.
Check out this ‘diagnostic image’:
The first person to correctly identify:
- the imaging modality,
- the structures shown, and
- the underlying diagnosis
will not only be a legend… but also a F.UCEM!
Oh, and radiologists are banned from this competition… especially you Scanman…
About Chris Nickson
CT face
Coronal section through lips tongue and nose, resembling a hamburger with a cocktail umbrella stuck in it.
The lips and tongue look oedematous, dare I say it angioedema boys, and that’s a nasal ETT
diagnosis -- angioedema requiring nasal intubation???
Oh, and the other side has an NGT?
• CT head (frontal plane)
• ET tube, nose, lips, tongue
• Nasal intubation for angioedema
Haha, well done Domhnall, I spent too much time thinking of the answer and didn’t refresh the browser to see if someone had come up with the answer before I posted.
Ditto!
agree, nasal intubation. I’m going with Ludwig’s
Modality is MRI.
I think it’s a coronal view of a nose and mouth.
The mouth looks huge, so I’m thinking angioedema of lips and tongue due to anaphylaxis. This diagnosis is supported by what appears to be a nasotracheal tube; looks like this patient would have been a tricky candidate for standard intubation!
-final year med student
Damn, I’m slow. My answer is also CT face, nasally intubated, NGT, for angioedema and in my neck of the woods, it’s ACE-I until proven otherwise.
Sagital cardiac image
Come on Nickson, I want my F.UCEM!!!! Spill the beans!!!
CT cisternogram
Nose, lips, tongue
CSF leak
CT Face -- coronal view. soft tissue windows.
Structures seen.
Nasal antrum. Nasal septum -- heterogenous soft tissue ? Inflammatory, traumatic change.
Upper lip -- not particularly swollen, so angioedema and anaphylaxis less likely
Lower lip
Chin
Tube from right nostril -- likely nasotracheal tube.
Tube from left nostril -- end on rapid rhino nasal tampon.
Homogenous mass between lips -- ? Gauze packing
Diagnosis
Epistaxis secondary to posterior bleed
Nasal intubation
Nasal tampon
Throat pack.
Sagital cardiac image!
Not accepting an image like this for FACEM? Disagree. It’s actually of far higher quality than one of the SCE images from 2012.1.
Never a good sign when the first thing the examiners have to do at the beginning of the SCE is apologise to the candidate for the poor quality of the image the candidate paid >$2K for someone to print with 6 months’ notice.
Even worse when google images, 5 minutes and an ageing hospital printer can do better.
FACEM LEAKED QUESTION ALERT: this is an image to be used in the upcoming FACEM clinical:
http://www.johnharveyphoto.com/Life/04_2006/BlurryMessHg.jpg#blurry%20pic
But it’ll be printed in black and white.
Very funny, couldn’t agree more
Would have loved to have been in your feedback session Dunc if you hadn’t got through
Brilliant!
C
Thanks Duncan
I feel another UCEM post coming on…
Based on recent changes to the UCEM examination system with CRaP -- this looks like yet another example of trying to attract intelligence towards the mean. The UCEM are developing a new examination structure to be implemented by 2015. The SLUM system will be an advance far beyond anybody’s wildest expectations…