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Critical Chest Radiographs: Can't-Miss Diagnoses Lars Grimm, MD, MHS | April 19, 2017 Many chest radiographs are first viewed by non-radiologists, who must be able to quickly recognize critical findings that identify patients who need emergent care. This image depicts a massive pneumoperitoneum following surgery. Image courtesy of Medscape. A pneumothorax occurs when air fills the space between the parietal and visceral pleura. A primary spontaneous pneumothorax occurs i...
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Diffuse Subcutaneous Emphysema Following Tracheal Perforation Andrew Keenan, William Browne, Maneesh Bhargava AJRCCM Articles in Press. Published on 17-March-2017 as 10.1164/rccm.201611-2394IM     A 77-year-old woman without prior lung disease experienced a respiratory arrest at home requiring an emergency medical response. A King LT TM supraglottic airway was placed as endotracheal intubation was unsuccessful. She developed massive soft tissue swelling during ...
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Images in Clinical Medicine Incidental Finding of Oleothorax Abhilash Koratala, Vikrampal Bhatti. N Engl J Med 2017; 376; e21 DOI:10.1056/NEJMicm1609176   An 86-year-old woman with hypertension who had been treated for pulmonary tuberculosis in the 1950s presented with burning chest and epigastric pain. She had no respiratory symptoms. After acute coronary syndrome was ruled out, she was treated for gastroesophageal reflux, which relieved her symptoms. A chest radiog...
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Effects of Variable Pressure Support Ventilation on Regional Homogeneity and Aeration Tommaso Mauri, Marta Lazzeri, Alfio Bronco, et al. Am J Respir Crit Care Med 2017; 195: e27-e28 Figure 1.Physiologic effects of variable pressure support assessed by electrical impedance tomography. After application of variable pressure support, distribution of tidal ventilation within the patient’s chest became more homogeneous (A and B) and was associated with improved lung aerati...
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Lobar Necrosis from Pulmonary Embolism Ramiro Fernandez ,  Jonathan M. Tomasko ,  Daphne Edgren, et al Am J Respir Crit Care Med 2017; 195: 685-686 A 63-year-old male heart transplant recipient with recurrent lower extremity deep vein thrombosis, receiving warfarin, with chronically reduced glomerular filtration rate (30 ml/min), presented with worsening cough and dyspnea. Laboratory testing revealed normal blood cell counts, mildly elevated C-reactive protein, and in...
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Images in Clinical Medicine Empyema Necessitatis Ronaldo A. Gismondi, M.D., Ph.D. Luiz F.F. de Souza, M.D. N Engl J Med 2017; 376: e13 DOI: 10.1056/NEJMicm1608914 A 40-year-old man presented with a 3-month history of fever, weight loss, dyspnea, and cough. Physical examination revealed a tender, bulging anterior thoracic mass and a small ulcerative lesion that was inferomedial to the right nipple (Panel A). Computed tomographic scans showed a pleural effusion (Pa...
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Images in Clinical Medicine Gas in the Left Atrium and Ventricle Mary Thomson, Fredy El Sakr. N Engl J Med 2017; 376: 683 A 60-year-old man with coronary artery disease, ischemic cardiomyopathy with biventricular implantable cardioverter–defibrillator placement, and atrial fibrillation presented with chest pain and numbness in both arms. During his initial presentation, he suddenly collapsed and became unresponsive. Computed tomographic (CT) angiography of his chest...
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Images in Clinical Medicine Disseminated Cysticercosis Qiang Meng, M.D., Ph.D. Lingchun Liu, M.D. N Engl J Med 2016; 375: e52 A 23-year-old woman presented with a 1-month history of headache, vomiting, recurrent episodes of syncope, weight gain, and leg pain. A physical examination revealed several subcutaneous nodules on the patient's face and trunk. Exophthalmos, fundal hemorrhage, neck rigidity, and a hypertrophic appearance of the thigh and calf muscles were ...
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Images in Clinical Medicine Swirl Sign — Intestinal Volvulus after Roux-en-Y Gastric Bypass N Engl J Med 2017; 376: e3 DOI: 10.1056/NEJMicm1601775 A 56-year-old man presented after a day and a half of midabdominal pain, nausea, and bilious emesis. The patient had undergone Roux-en-Y gastric bypass 7 years earlier. During the physical examination, tachycardia and tachypnea were noted. The abdominal examination showed a distended, tympanic abdomen with severe...
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IMAGING IN INTENSIVE CARE MEDICINE A nasoenteral feeding tube barking up the wrong tree Hafiz Abdul Moiz Fakih, Salim Daouk, Martin Runnstrom, et al. Intensive Care Med DOI 10.1007/s00134-017-4686-3 A 58-year-old woman with multiple co-morbidities, including a history of kidney and pancreas transplant, was admitted to the intensive care unit for management of septic shock. She had a prolonged course and had a small-bore nasoduodenal feeding tube placed under electr...
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