IMAGES IN CLINICAL MEDICINE Primary Cutaneous Blastomycosis Albert Alhatem, Kristin C. Smith N Engl J Med 2022; 386:e49DOI: 10.1056/NEJMicm2116178 A 53-year-old man presented to the dermatology clinic with a 4-month history of red, raised, itchy skin lesions on his left lower back and buttock. He had no known medical history and reported no constitutional or respiratory symptoms. He worked as a landscaper, often sustaining skin abrasions while trimming tre...

IMAGES IN CLINICAL MEDICINE Pneumatosis Intestinalis in Necrotizing Enterocolitis Lorraine Tong, Yu-Tang Chang N Engl J Med 2022; 386:1070DOI: 10.1056/NEJMicm2115830 An 11-day-old boy born at 39 weeks of gestation presented to the emergency department with watery diarrhea, bilious emesis, progressively worsening abdominal distention, and shock. There had been no complications during his birth, and he had been growing appropriately while receiving breast mi...

IMAGES IN CLINICAL MEDICINE Intestinal Tuberculosis Luis F. Oñate-Ocaña, Lizeth Pérez-Díaz N Engl J Med 2022; 386:e30DOI: 10.1056/NEJMicm2114345 A 36-year-old woman presented to the emergency department with a 1-day history of severe abdominal pain and a 2-week history of fever and cough. She had no known medical history and worked as a physician. On physical examination, diffuse, severe abdominal tenderness with rebound and guarding was observed. Computed...

IMAGES IN CLINICAL MEDICINE Page Kidneys Adam Min, Noah Ditkofsky N Engl J Med 2022; 386:673DOI: 10.1056/NEJMicm2114692 A 21-year-old woman presented to the emergency department with a 6-week history of abdominal pain and constipation. Her blood pressure was 162/108 mm Hg. She had a history of Hirschsprung’s disease and had undergone a partial colectomy and pull-through procedure during infancy. She had no history of hypertension or renal disease and repor...

IMAGES IN CLINICAL MEDICINE Cholesterol Embolization Syndrome after Carotid-Artery Stenting Wei Wang, Jifu Cai N Engl J Med 2022; 386:1265DOI: 10.1056/NEJMicm2114022 A 63-year-old man had purplish discoloration of the face develop after he underwent stenting and balloon dilation of the left common carotid artery. Shivering, sweating, and confusion developed immediately after artery dilation, along with a left gaze preference, dysarthria, and hemiparesis on...

IMAGES IN CLINICAL MEDICINE Radiographic Evolution of Presumed Septic Pulmonary Emboli Zarah Haleem, Jeremy D. Gradon N Engl J Med 2022; 386:1452DOI: 10.1056/NEJMicm2114270 A 41-year-old woman presented to the emergency department with confusion, shortness of breath, and chest pain. She had a history of opioid use disorder and had been injecting drugs daily. Her temperature was 39.4°C, the heart rate was 146 beats per minute, and the oxygen saturation was ...

IMAGES IN CLINICAL MEDICINE Thrombectomy in Acute Ischemic Stroke David C. Lauzier, Akash P. Kansagra N Engl J Med 2022; 386:1351DOI: 10.1056/NEJMicm2116727 A 63-year-old man with atrial fibrillation, hypertension, and type 2 diabetes presented to the emergency department with weakness on the left side and difficulty speaking, both of which had begun 6 hours earlier. On examination, he had dysarthria, 0/5 strength in the left arm, and 1/5 strength in the l...

IMAGES IN CLINICAL MEDICINE Pulmonary-Artery Aneurysm with Acute Dissection Asvin M. Ganapathi, Curt J. Daniels N Engl J Med 2022; 386:273DOI: 10.1056/NEJMicm2104225 A 35-year-old woman with idiopathic pulmonary arterial hypertension presented to the emergency department with a 1-day history of chest pain. She had been undergoing evaluation for lung transplantation and was known to have a 12-cm pulmonary-artery aneurysm that had been enlarging over the pre...

IMAGES IN CLINICAL MEDICINE Bronchoesophageal Fistula Pierluigi di Mauro and Vittorio Ferrari N Engl J Med 2020; 383:e137DOI: 10.1056/NEJMicm2018535 A 50-year-old man presented to the emergency department with a 5-day history of shortness of breath, chest pain, and a cough. Fifteen days before presentation, he had received a diagnosis of large-cell neuroendocrine carcinoma of the lung with brain metastases. The oxygen saturation was 93% while the patient w...

IMAGES IN CLINICAL MEDICINE Green UrineVCAD510 JN0-643 Maja Boshkovska Spaseski, and Dejan Spaseski N Engl J Med 2020; 383:e128DOI: 10.1056/NEJMicm2017137 A 62-year-old man with chronic obstructive pulmonary disease presented to the emergency department with a 2-day history of dyspnea and was found to have hypercapnic respiratory failure. Intubation was performed, mechanical ventilation and a continuous infusion of propofol were initiated, and the patient ...