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Images in Clinical Medicine Cholesterol Embolization after Transcatheter Aortic-Valve Replacement Lu Devy, M.D., Florence Brunet-Possenti, M.D. Bichat Hospital Paris, France devy.lu87@yahoo.fr N Engl J Med 2016; 375: e25 An 88-year-old man with a history of myocardial infarction for which he had required quadruple coronary-artery bypass grafting presented with mottled-appearing purple discoloration of the skin on his toes. One month earlier, he had undergone tran...
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Images in Clinical Medicine Urinary Tract Tuberculosis Hiromichi Masuda, M.D. Koji Kamada, M.D., Ph.D. Shobara Red Cross Hospital Shobara, Japan m01081hm@jichi.ac.jp N Engl J Med 2016; 375; 1068 A 76-year-old man with diabetes and a 2-year history of mediastinal lymphadenopathy of un- known cause presented with fever and fatigue. Pyuria was seen on urinalysis. Contrast-enhanced computed tomography (CT) of the abdomen showed mild dilatation of the left renal pelvi...
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Images in Clinical Medicine Pneumorrhachis, Pneumothorax, and Subcutaneous Emphysema Christoph Sträube, Martin Vazan N Engl J Med 2016; 375: e18 DOI: 10.1056/NEJMicm1506684 A 65-year-old man was admitted to the hospital to undergo adjuvant radiotherapy after having previously undergone tumor mass reduction and anterior and posterior stabilizing spinal surgery for a synovial sarcoma. On physical examination, ballooning of the right paravertebral area was noted, wh...
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Images in Clinical Medicine Emphysematous Prostatitis Wang H, Shih M. N Engl J Med 2016; 375: 879 DOI: 10.1056/NEJMicm1507124 A 42-year-old man with diabetes presented to the emergency department with severe dysuria and incontinence, which he had had for several days. Laboratory studies were notable for pyuria on urinalysis, leukocytosis (a white-cell count of 10,820 per cubic millimeter), elevated C-reactive protein levels (134.1 mg per liter), hyperglycemia ...
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IMAGES IN CLINICAL MEDICINE Takayasu's Arteritis Saori Sakaue, M.D.Noboru Hagino, M.D. N Engl J Med 2016; 375:675 August 18, 2016 DOI: 10.1056/NEJMicm1503040 A previously healthy 36-year-old Japanese woman presented with blood pressure that was difficult to control after she had undergone an emergency cesarean section at 29 weeks of gestation because of severe hypertension and fetal growth restriction. During pregnancy, her blood pressure had been more than 180/100 mm Hg,...
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Hypopyon and Klebsiella Sepsis Osama M. Mustafa, Patricio M. Aduriz-Lorenzo N Engl J Med 2016; 374: e33 DOI: 10.1056/NEJMicm1509932 A 49-year-old man with a history of diabetes mellitus reported having blurry vision in the right eye 3 days after being admitted to the hospital for investigation of elevated levels of creatinine, liver enzymes, and bilirubin following 9 days of generalized weakness. He had been receiving treatment for bacteremia caused by Klebsiella pne...
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Images in Clinical Medicine Hyperkalemia after Missed Hemodialysis Nikoloz Koshkelashvili, M.D. Julie Y.K. Lai, M.D. Albert Einstein Medical Center Philadelphia, PA nika.koshkelashvili@gmail.com N Engl J Med 2016; 374: 2268 DOI: 10.1056/NEJMicm1512236 A 48-year-old man with a history of end-stage renal disease who had undergone parathyroidectomy owing to tertiary hyperparathyroidism 1 month earlier presented to the emergency department with weakness and diffuse m...
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IMAGES IN CLINICAL MEDICINE Hair-on-End Sign Leslie Martin, M.D., Forrest Rackard, B.S. N Engl J Med 2016; 374:e23May 12, 2016 DOI: 10.1056/NEJMicm1510045 A 35-year-old man with a history of sickle cell disease presented with a sickle cell crisis and headaches. Noncontrast computed tomography (CT) of the head revealed a thickened calvaria with perpendicular proliferation of the trabeculae, a finding termed the hair-on-end sign (Panels A and B). The hair-on-end sign was hi...
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IMAGES IN CLINICAL MEDICINE Diaphragmatic Hernia Causing Lung Collapse Muhammad Yasin, M.D., and James C. Reed, M.D. N Engl J Med 2016; 374:1874 May 12, 2016 DOI: 10.1056/NEJMicm1415660 A 54-year-old man with a history of cerebral palsy and mental impairment presented with acute respiratory distress. He was afebrile and had a nonproductive cough. Physical examination revealed the use of accessory muscles of ventilation, decreased right hemithorax expansion, and an absence...
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Images in Clinical Medicine Geographic Tongue lena Varoni, D.D.S., Ph.D., Sem Decani, D.D.S. N Engl J Med 2016; 374: 670 A 73-year-old man was referred to this clinic by his primary care physician, who noted an unusual red lesion that had been moving across the dorsum of the man's tongue for approximately 3 months. The patient was a former smoker who was being treated for essential hypertension, hypercholesterolemia, and hyperuricemia. On oral examination, a well...
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