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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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Images in Clinical Medicine Ventriculoperitoneal-Shunt Placement for Normal-Pressure Hydrocephalus Mahmoud A. AbdelRazek, Nagagopal Venna N Engl J Med 2017; 377: e35 DOI:10.1056/NEJMicm1701226 A 70-year-old woman presented to the neurology clinic with a 2-year history of gait disturbance, cognitive impairment, and urinary incontinence. Examination revealed a Mini–Mental State Examination (MMSE) score of 12 (on a scale of 0 to 30, with higher scores representing better per...
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Images in Clinical Medicine Talaromyces marneffei Infection Zixiang Si,  Jianjun Qiao N Engl J Med 2017; 377: 2580 DOI:10.1056/NEJMicm1704164 A  29-year-old man presented to an outpatient clinic with a 2-month history of fever, cough, dyspnea, and weight loss, as well as skin lesions that had developed on his face, neck, trunk, arms, and legs over a period of 2 weeks. Physical examination revealed extensive umbilicated papules (Panel A). A biopsy specimen obtained from a ...
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IMAGES IN CLINICAL MEDICINE Pneumatosis Cystoides Intestinalis Yuusaku Sugihara, M.D., Ph.D., and Hiroyuki Okada, M.D., Ph.D. N Engl J Med 2017; 377:2266 DOI: 10.1056/NEJMicm1701357 A 48-year-old woman presented to an outpatient clinic with a several-month history of abdominal fullness. She also had a history of eosinophilic pneumonia, which had been treated continuously with glucocorticoids for 7 years. On examination, her abdomen was distended but soft, with normal bowe...
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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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