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Images in Clinical Medicine Falciform Ligament Sign Po-Chen Chou, Yu-Jang Su N Engl J Med 2017; 377: e28 DOI:10.1056/NEJMicm1613914 An 87-year-old woman with a history of hypertension and peptic ulcer disease presented to the emergency department with a 3-day history of abdominal distention, pain in the epigastrium, and watery diarrhea. She had hypotension (blood pressure of 78/49 mm Hg), and diffuse abdominal tenderness with guarding was observed on physical examination. ...
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Images in Clinical Medicine Decompression Sickness N Engl J Med 2017; 377: 1568 Qing Sun, Guangkai Gao DOI:10.1056/NEJMicm1615505 A  42-year-old man presented to the emergency department with palpitations, arthralgias, and vomiting 2 hours after scuba diving to a depth of 26 m. The physical examination revealed diffuse violaceous skin mottling over his trunk and arms (Panel A). Laboratory values were notable for mild elevations in levels of serum aminotransferases, creati...
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IMAGES IN CLINICAL MEDICINE Compartment Syndrome Aileen F. Egan, M.B., B.A.O., M.Ch., and Kevin C. Cahill, M.D. N Engl J Med 2017; 377:1877 November 9, 2017 DOI: 10.1056/NEJMicm1701729 A 26-year-old man presented to the emergency department with a painful, swollen left hand (Panel A). He had been lying on the ground for more than 13 hours after using illicit drugs. The physical examination revealed edema in the left hand and forearm. Active and passive motion of the hand ...
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Images in Clinical Medicine Takotsubo Cardiomyopathy Abhishek Maiti, Abhijeet Dhoble N Engl J Med 2017; 377: e24 DOI:10.1056/NEJMicm1615835 A  61-year-old woman with hypertension and hypothyroidism presented to the emergency department with acute onset of severe chest pain. She reported multiple recent stressors, including the death of her dog. An electrocardiogram showed ST-segment elevation in the anterolateral leads. Emergency coronary angiography revealed normal coron...
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Tension Pneumoperitoneum Associated with Nasopharyngeal Catheter Oxygen Delivery during Bronchoscopy Karim El-Kersh, Hala Karnib Am J Respir Crit Care Med 2017 Published on 29-June-2017 as 10.1164/rccm.201701-0181IM A 61-year-old female with chronic lymphocytic leukemia was undergoing bronchoscopy with bronchoalveolar lavage. The patient never smoked and she did not have any underlying chronic gastric disease. The bronchoscopy was performed in supine position under conscio...
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Images in Clinical Medicine Calcium Oxalate Crystals in Ethylene Glycol Toxicity Mohamad Hanouneh, Teresa K. Chen N Engl J Med 2017; 377: 1467 An 80-year-old man with a remote history of alcohol-use disorder presented to the emergency department with altered mental status after a fall at home. He was somnolent and unable to provide any further history. Serum studies revealed a creatinine level of 2.4 mg per deciliter (212 μmol per liter; reference range, 0....
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Images in Clinical Medicine Pulmonary Foreign-Body Granulomatosis Dustin A. Staloch, J. Stephen Hedley N Engl J Med 2017; 377: 1273 A 31-year-old woman who was receiving long-term total parenteral nutrition after having undergone Roux-en-Y gastric bypass that was complicated by small-bowel resection presented to the pulmonology clinic with exertional dyspnea that had progressed over the course of 1 year. She had normal oxygen saturation while breathing ambient air and was...
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Aberrant Right Subclavian Artery on EBUS Nicholas M. Mark, David K. Madtes Am J Respir Crit Care Med 2017 Published on 06-July-2017 as 10.1164/rccm.201704-0706IM A 70 year old man underwent bronchoscopy under general anesthesia for biopsy of mediastinal adenopathy due to suspected lymphoma. The airways appeared normal, however on endobronchial ultrasound (EBUS) examination, a thick walled pulsatile mass posterior to the trachea was visualized (A). Doppler ultrasound (B) re...
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IMAGES IN CLINICAL MEDICINE Eosinophilic Bronchitis Yanhong Ren, M.D., Ph.D., and Huaping Dai, M.D. N Engl J Med 2017; 377:873 DOI: 10.1056/NEJMicm1616156 A 43-year-old woman presented with an 8-month history of progressively worsening nonproductive cough. She had been treated with antibiotic agents for presumed bronchitis, but her cough continued to worsen. Her vital signs were normal, the pulmonary examination was notable for wheezing in both lungs, and the white-cell c...
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Imaging in Intensive Care Medicine Fat embolism syndrome Anselmo Caricato, Giovanni Russo, Daniele Guerino Biasucci, Maria Giuseppina Annetta Intensive Care Med 2017; 43: 1411-1412 A 19-year-old man was admitted to our emergency department after a road accident. He presented with bilateral femoral fractures that were promptly treated with external fixators. After surgery, he was monitored in ICU. Twenty-four hours after admission, fever, tachycardia, dyspnea, and hypoxia a...
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