Images in Clinical Medicine Left-Middle-Lobe Pneumonia Ling Yuan Kong, Yves Longtin N Engl J Med 2017; 377: e8 DOI:10.1056/NEJMicm1700661 A 34-year-old man presented to the emergency department with a 5-day history of fever, cough, and dyspnea. He had received a diagnosis of situs inversus when he was 2 years of age, after a chest radiograph had been obtained in order to evaluate a cough. Physical examination was notable for heart sounds in the right side of his chest and...

CASE VIGNETTE A Woman with Septic Shock Rebecca E. Berger, M.D. http://www.nejm.org/doi/full/10.1056/NEJMclde1705277#discussion Editor's Comment Management of Septic Shock — Polling Results Rebecca E. Berger, M.D., and Julie R. Ingelfinger, M.D. Management of septic shock was transformed in 2001 with the publication of the randomized, controlled trial, “Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock,” by Emanuel Rivers and colleagues.[1] Tha...

Imaging in Intensive Care Medicine Resuscitated unconscious male: Lichtenberg’s sign lighting the way Andrew Lindford, Jyrki Vuola, Esko Kankur Intensive Care Medicine 2017; 43: 1148–1149 An intubated unconscious 18-year-old male was admitted to the trauma center with a fern-leaf erythematous pattern on his right chest and flank, a second-degree upper chest burn, and a deep full-thickness occipital scalp burn (Fig. 1a). Earlier in the day his military unit had completed...

Chest X-Rays: 16 Subtle But Key Findings You Need to Know Lars Grimm, MD, MHS | August 2, 2017 The chest radiograph is one of the views most commonly ordered by clinicians, and it is frequently first viewed by non-radiologists. Although many disease processes are obvious at first glance on chest radiographs, clinicians must be careful not to miss more subtle findings. This image shows a solitary pulmonary nodule (circle) in the left midlung. Image courtesy of Lars Grimm, ...

Imaging in Intensive Care Medicine Echography of pneumatosis intestinalis and hepatic portal venous gas in a patient with septic shock Jiaqi Xu, Shangzhong Chen, Jing Yan, Jianjun Zhang Intensive Care Medicine 2017; 43: 1152–1153 An 88-year-old male patient was admitted to our ICU with a diagnosis of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure. During hospitalization the patient presented with abdominal pain, abdominal dist...

CASE VIGNETTE A Woman with Septic Shock Rebecca E. Berger, M.D. http://www.nejm.org/doi/full/10.1056/NEJMclde1705277#discussion Ms. Jones is a 65-year-old woman with a history of hypertension who presents to the emergency department with a 3-day history of chills and dysuria. The only medication she is taking is amlodipine, at a dose of 10 mg daily; she had had normal electrolyte levels and renal function at a routine visit 6 weeks earlier. On arrival at the emergency dep...

IMAGES IN CLINICAL MEDICINE Mobile Aortic Thrombi Ville Sallinen, M.D., Ph.D., and Pirkka Vikatmaa, M.D., Ph.D. N Engl J Med 2017; 377:e2 July 13, 2017 DOI: 10.1056/NEJMicm1702263 An 85-year-old woman with essential thrombocytosis, coronary artery disease, and a remote history of venous thromboembolism presented with abdominal pain, fever, vomiting, and diarrhea. Physical examination revealed tenderness and guarding in the lower abdomen. Laboratory results showed a white-...

Hidden Heart Disease: 19 Dermatologic Clues You Should Know Rashid M Rashid, MD, PhD; Brittany Sambrano Barros, MD | June 13, 2017 Image from Medscape. Patients with cardiac disease often present with manifestations on the skin. The above image, for example, shows a patient with sarcoidosis—a multisystem, inflammatory disease—presenting with lupus pernio, appearing as nodules on the nasal tip and sidewall. Cutaneous signs such as this can play a valuable role in guiding p...

Hidden Heart Disease: 19 Dermatologic Clues You Should Know Rashid M Rashid, MD, PhD; Brittany Sambrano Barros, MD | June 13, 2017 Image from Medscape. Patients with cardiac disease often present with manifestations on the skin. The above image, for example, shows a patient with sarcoidosis—a multisystem, inflammatory disease—presenting with lupus pernio, appearing as nodules on the nasal tip and sidewall. Cutaneous signs such as this can play a valuable role in guiding p...

Hidden Heart Disease: 19 Dermatologic Clues You Should Know Rashid M Rashid, MD, PhD; Brittany Sambrano Barros, MD | June 13, 2017 Image from Medscape. Patients with cardiac disease often present with manifestations on the skin. The above image, for example, shows a patient with sarcoidosis—a multisystem, inflammatory disease—presenting with lupus pernio, appearing as nodules on the nasal tip and sidewall. Cutaneous signs such as this can play a valuable role in guiding p...