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IMAGES IN CLINICAL MEDICINE Multiple Renal Arteries Sahib Y. Tuteja and Bence Forgac N Engl J Med 2019; 381:862DOI: 10.1056/NEJMicm1902894
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IMAGES IN CLINICAL MEDICINE Epiglottitis Nikita Chapurin and Alexander Gelbard N Engl J Med 2019; 381:e15DOI: 10.1056/NEJMicm1816761 A previously healthy, fully immunized 48-year-old man presented to an urgent care clinic with a 3-day history of odynophagia, fever with temperatures of up to 40°C, and progressive shortness of breath. A lateral radiograph of the neck showed the “thumb sign” (Panel A, arrow), which was suggestive of an enlarged epiglottis. ...
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IMAGES IN CLINICAL MEDICINE Emphysematous Cholecystitis Sondes Mhamdi and Kais Mhamdi N Engl J Med 2019; 381:e14DOI: 10.1056/NEJMicm1814551 An 80-year-old man with a history of hypertension presented to the emergency department with a 2-day history of abdominal pain in the right upper quadrant. The patient was febrile. On physical examination, he had abdominal tenderness in the right upper quadrant, and Murphy’s sign was positive. Laboratory studies reveal...
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IMAGES IN CLINICAL MEDICINE Fish Bone Perforation Takafumi Taguchi and Hiroyuki Kitagawa N Engl J Med 2019; 381:762DOI: 10.1056/NEJMicm1900442 A 73-year-old man presented to the emergency department with the acute onset of severe lower abdominal pain. He recalled eating yellow-tail fish the day before the onset of the pain. His temperature was 38°C, blood pressure 122/69 mm Hg, and heart rate 77 beats per minute. On physical examination, he had tenderness ...
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IMAGES IN CLINICAL MEDICINE Air in the Spleen Simon De Freitas, Evan G. Wong N Engl J Med 2019; 381:566DOI: 10.1056/NEJMicm1817266 A 56-year-old woman presented to the emergency department with a 1-month history of epigastric and left-upper-quadrant abdominal pain. Her medical history included polysubstance use disorder (including cocaine and heroin use) and hepatitis C virus infection, as well as rheumatoid arthritis, for which she had been taking naproxe...
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IMAGES IN CLINICAL MEDICINE Thrombotic Thrombocytopenic Purpura Shruti Bhandari and Rohit Kumar N Engl J Med 2019; 380:e23DOI: 10.1056/NEJMicm1813768 A 35-year-old man presented to the emergency department with a 2-day history of abdominal pain, headache, and brown urine. On examination, his temperature was 37.5°C. He was alert and oriented to time, place, and self, and he had no purpura or petechiae. Laboratory evaluation revealed a hemoglobin level of 8....
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IMAGES IN CLINICAL MEDICINE Pneumatosis Cystoides Intestinalis with Pneumoperitoneum Francesco Pata, and Salomone Di Saverio N Engl J Med 2019; 380:e17DOI: 10.1056/NEJMicm1808960 A 61-year-old woman presented to the emergency department with acute onset of diffuse abdominal pain and a 1-week history of diarrhea and vomiting. Her medical history included chronic obstructive pulmonary disease, which was being treated with an inhaled glucocorticoid and a long...
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Intensive Care Medicine Nasogastric tube ending in the right pleura of an intubated patient Paparoupa, M., Yan, Y., Möller, M. et al. Intensive Care Med (2018). https://doi.org/10.1007/s00134-018-5460-x An 89-year-old woman was treated in our intensive care unit with Escherichia coli urosepsis. The patient developed multiple organ failure and became intubated and mechanically ventilated. On the third intensive care day, a new 16Fr. type “Levin” nasogastric tube was ...
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IMAGES IN CLINICAL MEDICINE Portal Venous Gas Ming Cui, and Xin Lu N Engl J Med 2018; 379:e37 DOI: 10.1056/NEJMicm1806082 A 72-year-old man presented to the emergency department with an 11-hour history of periumbilical abdominal pain and inability to pass flatus. His medical history included chronic lymphocytic leukemia (for which he had been taking ibrutinib), type 2 diabetes, and chronic hepatitis B virus infection. The pulse was 155 beats per minute, and the blood press...
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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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