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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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Usefulness of the Pulmonary Artery Catheter in a Perioperative Setting Øyvind S. Svendsen, Gaute K. Wathle, Paul Husby, et al. Am J Respir Crit Care Med 2016; 194: 1426-1427 An obstruction in superior vena cava (SVC) may decrease blood drainage from the upper half of the body, leading to head and neck swelling, upper extremity edema, and dyspnea, as well as cerebral edema. This condition, termed SVC syndrome, is rare during cardiac surgery. Malposition of SVC cannu...
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Images in Clinical Medicine Neurogenic Megacolon in Spinal Cord Injury Rukma R. Govindu, Michelle Kelley N Engl J Med 2016; 375: e45 DOI:10.1056/NEJMicm1604013 Copyright © 2016 Massachusetts Medical Society. A  44-year-old man with a 20-year history of quadriplegia from a gunshot wound to the neck presented to the emergency department with symptoms of a urinary tract infection. His medical history included chronic megacolon and neurogenic bladder, and he had been admitted...
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Images in Clinical Medicine Skin Mottling Damien Contou, Nicolas de Prost N Engl J Med 2016; 375: 2187 A 68-year-old woman was admitted to the intensive care unit with respiratory failure and hypotension. Her blood pressure was 70/50 mm Hg, and her heart rate was 125 beats per minute. Physical examination revealed skin mottling on the legs (Panel A). Laboratory values were notable for an arterial- blood lactate level of 4.5 mmol per liter (normal value, <2.0),...
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