I was wonder with nginx can I:
Check if content-type == "image/x-jpeg" || content-type == "image/png" || content-type == "image/gif"
If true && referrer != "mysite.com" && referrer != "":
Return a 404 result or an image of my choice.
Update: This is a duplicate. But I could not find it (the duplicate) until I posted. So I am leaving this here for others.