No ventilation, no ARDS: insights from four-dimensional computed tomography as dynamic imaging Okamura, G., Nishiyama, S., Ono, S. et al. Intensive Care Med (2024). https://doi.org/10.1007/s00134-024-07643-w A 63-year-old male, who was in remission from myelodysplastic syndrome after bone marrow transplantation, had previously undergone partial resection of the right upper lobe due to pulmonary aspergillosis. Over a year later, he presented with dyspnea and subse...

IMAGES IN CLINICAL MEDICINE Flail Chest Zhi Hu, Biao Wang N Engl J Med 2024;391: e22 A 59-year-old man with a history of chronic obstructive pulmonary disease was brought to the emergency department after a motor vehicle collision. The steering wheel of the patient’s car had struck his chest after the airbag had not deployed. His heart rate was 99 beats per minute, blood pressure 123/84 mm Hg, respiratory rate 30 breaths per minute, and oxygen saturation 9...

IMAGES IN CLINICAL MEDICINE Alpha1-Antitrypsin Deficiency José Maria Hernández Pérez N Engl J Med Published August 17, 2024 DOI: 10.1056/NEJMicm2403183 A 60-year-old woman with a 15-pack-year smoking history was referred to the pulmonology clinic owing to several years of dyspnea on exertion. She had quit smoking at 43 years of age. Her father had died from emphysema. Her oxygen saturation was 93% while she was breathing ambient air. Physical examinatio...

Imaging in Intensive Care Medicine Published: 19 June 2024 18F-fluorodeoxyglucose positron emission tomography/computed tomography differentiates between pneumonia and atelectasis in a mechanically ventilated patient Intensive Care Med (2024). https://doi.org/10.1007/s00134-024-07505-5 Differentiation between atelectasis and pneumonia in critically-ill patients can be challenging on regular computed tomography (CT). In this image the additional value of...

IMAGES IN CLINICAL MEDICINE Necrotizing Soft-Tissue and Retropharyngeal Space Infections and Mediastinitis Martin A. Gomez, Beatriz Mejia N Engl J Med 2024;391: e5 DOI: 10.1056/NEJMicm2312959 A 50-year-old man with no known medical history presented to the emergency department with a 3-day history of tooth and jaw pain on the left side, fever, and shortness of breath. He lived in a rural area and had never visited a physician or dentist. Physical examin...

A Coin in the Airway Victor Bor-Chang Hsue, Vijay Patel N Engl J Med 2024; 390: e33 DOI: 10.1056/NEJMicm2312266 A healthy 14-year-old boy presented to the emergency department with a 6-hour history of hoarseness and difficulty swallowing after having accidentally swallowed a coin. On physical examination, the patient was breathing comfortably without stridor or drooling. Radiographs of the chest (Panel A, posteroanterior view) and ...

IMAGES IN CLINICAL MEDICINE Spontaneous Oral Purpura in Immune Thrombocytopenia Jakob L. Drivenes, Anette Bygum N Engl J Med 2024; 390:1029DOI: 10.1056/NEJMicm2312260 A 76-year-old man presented to the dermatology clinic with a 2-day history of blood-filled blisters on the tongue. The lesions had appeared suddenly without antecedent trauma. He reported no other bleeding symptoms. The physical examination was notable for multiple hemorrhagic bullae on the t...

IMAGES IN CLINICAL MEDICINE Green Dialysis Effluent and Plasma Bao-ping Xu, Xiao-tao Wang N Engl J Med 2024; 390:e27DOI: 10.1056/NEJMicm2311085 A 72-year-old man with end-stage kidney disease who began receiving continuous renal-replacement therapy in the intensive care unit (ICU) was noted to have green-colored dialysis effluent and plasma. Seven hours earlier, the patient had presented to the emergency department with a gastrointestinal perforation. An e...

JAMA Clinical Challenge  October 30, 2023 Coin-Shaped Opacities in the Stomach Neil Shadbeh Evans, Paul Aronowitz, Timothy E. Albertson JAMA. 2023;330(20):2016-2017. doi:10.1001/jama.2023.19032 Case A50-year-old man with end-stage kidney disease receiving hemodialysis was admitted to the hospital for treatment of calciphylaxis and foot cellulitis. His home medications included sevelamer and hydrocodone-acetaminophen (10...

JAMA Clinical Challenge  October 30, 2023 Coin-Shaped Opacities in the Stomach Neil Shadbeh Evans, Paul Aronowitz, Timothy E. Albertson JAMA. 2023;330(20):2016-2017. doi:10.1001/jama.2023.19032 Case A50-year-old man with end-stage kidney disease receiving hemodialysis was admitted to the hospital for treatment of calciphylaxis and foot cellulitis. His home medications included sevelamer and hydrocodone-acetaminophen (10...