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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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IMAGING IN INTENSIVE CARE MEDICINE Quick diagnosis of venous air embolism Shakeer Shaik, Jyoti Burad and Mohamed Al‐Ismaili Intensive Care Med DOI 10.1007/s00134-016-4660-5 A 38-year-old man with idiopathic dilated cardiomyopathy and chronic atrial brillation presented with symptoms of heart failure. He underwent temporary override pacemaker insertion through right femoral access. A few hours later, he developed shock. Central venous (femoral) and arterial ...
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Images in Clinical Medicine Acute Rheumatic Fever with Erythema Marginatum Makoto Saito, Shuji Hatakeyama N Engl J Med 2016; 375: 2480 DOI: 10.1056/NEJMicm1601782 A previously healthy 36-year-old man presented with a 1-month history of fever and pain in both shoulders and knees, which had been preceded by a sore throat 2 weeks before the onset of fever. Laboratory studies were notable for a white-cell count of 13,800 per cubic millimeter (85% neutrophils), a C-r...
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Images in Clinical Medicine Uterine Rupture with Protruded Legs in a Large Amniocele Pierre-Emmanuel Bouet, M.D., CharlyneHerondelle, M.D. N Engl M Med 2016; 375; e51 A 33-year-old asymptomatic woman (gravida 6, para 5) presented at 22 weeks of gestation with a large herniation of the amniotic sac through the left uterine wall that was detected by routine ultrasonography. She had had five previous cesarean sections through a transverse incision of the lower ut...
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Images in Clinical Medicine Tongue Fasciculations in Organophosphate Poisoning Bharath A. Chhabria, M.B., B.S. Ashish Bhalla, M.D. N Engl J Med 2016; 375: e7 DOI: 10.1056/NEJMicm1605077 Copyright © 2016 Massachusetts Medical Society. A 15-year-old boy who lived with his family on a farm presented to the emergency department with a 1-day history of vomiting, diarrhea, and altered sensorium. On initial assessment, he was drowsy and had tachypnea and hypote...
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Images in Clinical Medicine Tinea Imbricata Carrick Burns, M.D. Johannah Valentine, M.D N Engl J Med 2016; 375: 2272 DOI: 10.1056/NEJMicm1516757 Copyright © 2016 Massachusetts Medical Society An 18-year-old Fijian woman presented with a 3-year history of a concentric, scaly rash on her shoulders; the rash was also present on her trunk, arms, and legs (not shown). The rash was pruritic and progressively spread to involve approximately 70% of the body-surface ar...
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