Alright, here’s the final answer to the xray I posted last Friday. This patient was using a ThermaCare Menstrual HeatWrap by Pfizer. It was applied to her back, though, for relief from back pain. It was not apparent during the trauma activation exam, even with clothes off, until we logrolled her to examine her back.

Each pocket in the wrap contains a granular mixture of activated carbon, iron powder, salt and a few other ingredients. When the wrap is removed from its vacuum pouch it heats up to 104F (40C) and stays hot for up to 8 hours. The iron shows up on xrays. The regular pattern is a giveaway that this is not some other problem (stones, drug pouches in the colon).

Bottom line: Remember, conventional xrays collapse a 3D space onto a 2D image, so you can’t tell how deep objects are (anterior to posterior). This is another reminder to be thorough when examining your patient. They can hide things anywhere!

Disclaimer: I do not have any financial or other interest in Pfizer Inc.

Remember that weird pelvic xray with the unidentifiable item on it last week? Click here to review it. Lots of interesting guesses came in on this one. Two people got close, but not close enough.

Here’s a picture of what we found when we logrolled the patient to examine the back. See if you can figure it out and leave a comment before I post the complete answer later this morning.