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Re-expansion pulmonary oedema Alice Petiot, Sammy Tawk, Benoît Ghaye Lancet 2018; 392: 507 A 46-year-old man presented to the emergency department with moderate dyspnoea and a 4-day history of cough. His medical history also included alcoholic cirrhosis with portal hypertension and ascites. On admission, a chest x-ray showed complete white-out of the right hemithorax with contralateral mediastinal deviation compatible with a large pleural effusion—presumed to be hepatic hy...
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IMAGES IN CLINICAL MEDICINE Corrigan’s Pulse and Quincke’s Pulse Hector I. Michelena, and Maurice Enriquez-Sarano N Engl J Med 2018; 379:e9 DOI: 10.1056/NEJMicm1715353 A 58-year-old man was referred to the cardiology clinic for evaluation of exertional dyspnea. Twelve years before presentation, he had undergone a bioprosthetic aortic-valve replacement for treatment of severe bicuspid aortic stenosis and for repair of an ascending aortic aneurysm. On physical examination, h...
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IMAGES IN CLINICAL MEDICINE Vibrio vulnificus Infection Jin Park, and Chang-Seop Lee N Engl J Med 2018; 379:375 DOI: 10.1056/NEJMicm1716464 A 71-year-old man presented to the emergency department with a 2-day history of fever and excruciating pain in his left hand that had developed 12 hours after eating raw seafood. He had a history of type 2 diabetes mellitus and hypertension and was undergoing hemodialysis for end-stage renal disease. At the time of presentation, hemor...
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IMAGES IN CLINICAL MEDICINE Cryptococcus neoformans Meningoencephalitis Raul Recio, and Ana Perez-Ayala N Engl J Med 2018; 379:281 DOI: 10.1056/NEJMicm1801051 A 36-year-old man presented to the emergency department with a 2-week history of fever, headache, drowsiness, and photophobia. He was previously healthy and was sexually active with men. The physical examination was notable for a temperature of 38.3°C and neck stiffness. Computed tomography of the head was normal. T...
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IMAGES IN CLINICAL MEDICINE Aspiration of a Chicken Bone Huey Ming Seah, Marcela Mautone N Engl J Med 2018; 378:e25 DOI: 10.1056/NEJMicm1713423 A 78-year-old man presented to the emergency department with stridor, shortness of breath, and fever (38.1°C). Five days earlier, he had come to the emergency department with the sensation of having a foreign body in his throat, approximately an hour after a choking episode that had occurred while he was eating chicken. At that ti...
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IMAGES IN CLINICAL MEDICINE Raindrop Skull Fabio Solis, Cesar Gonzalez N Engl J Med 2018; 378:1930 DOI: 10.1056/NEJMicm1714471 A 46-year-old man presented to the emergency department with a 1-month history of fatigue, shortness of breath, and low back pain and report of a weight loss of 30 kg over the previous 10 months. On physical examination, his conjunctiva and palms were pale. Laboratory evaluation revealed a hemoglobin level of 4.9 g per deciliter (reference range, ...
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IMAGES IN CLINICAL MEDICINE Colon Cutoff Sign Po-Yi Chen, M.D. N Engl J Med 2018; 378:1621 DOI: 10.1056/NEJMicm1714270 A 74-year-old woman presented to the emergency department with a 3-day history of lower abdominal pain, nausea, and vomiting. She had been unable to pass any stool for 1 week and reported having had small-caliber stool during the previous 6 months. On physical examination, bowel sounds were reduced, and the patient had periumbilical tenderness. Laboratory...
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IMAGES IN CLINICAL MEDICINE Electrocardiographic Changes in Hypothermia Eleftheria Kampouri, M.D., and Julien Vaucher, M.D. N Engl J Med 2018; 378:460 DOI: 10.1056/NEJMicm1704534 A 76-year-old woman with a history of dementia and coronary heart disease was brought to the emergency department after she had been found lying outdoors for an undetermined period; her core body temperature was 26°C (78.8°F) at presentation. An electrocardiogram showed prominent Osborn waves, al...
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IMAGES IN CLINICAL MEDICINE Phlegmasia Cerulea Dolens with Compartment Syndrome Hsin-Ti Lai, and Shu-Hung Huang N Engl J Med 2018; 378:658 DOI: 10.1056/NEJMicm1704996 An 81-year-old man with hypertension presented to the emergency department with pain and swelling of the left thigh and lower leg that had developed during the previous several hours. He had no history of recent surgery or trauma and no known personal or family history of clotting disorders. The left lower l...
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Images in Clinical Medicine Pneumomediastinum Associated with Influenza A Infection Christopher T. Mansbridge, Matthew Inada-Kim N Engl J Med 2018; 378: e1 DOI:10.1056/NEJMicm1702849   A  previously healthy 33-year-old man presented to the emergency department with a 10-day history of lethargy and feeling unwell. His temperature was 38.3°C, and he had tachycardia, with an oxygen saturation of 85% while breathing 15 liters of oxygen per minute through a nonrebreather ...
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