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[Intensive Care Medicine Imaging]: Is the ventilator switching from inspiration to expiration at the right time? Look at waveforms! Mojoli F, Iotti GA, Arnal JM, et al. Is the ventilator switching from inspiration to expiration at the right time? Look at waveforms! Intensive Care Med DOI 10.1007/s00134-015-4174-6 During normal unassisted breathing, inspiratory-to-expiratory flow reversal occurs well before full relaxation of inspiratory muscles: the exact time depends on b...
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[NEJM Clinical Medicine Imaging]: Lancisi's Sign Mansoor AM, Mansoor SE. Lancisi's sign. N Engl J Med 2015; 374: e2 A 60-year-old man with nonischemic cardiomyopathy presented with progressive dyspnea and weight gain of approximately 9 kg that had developed over a period of 2 to 3 weeks. On examination, a grade 2/6 holo- systolic murmur that augmented with inspiration was noted at the left lower sternal border. Examination of the neck revealed a palpable, monomorphic veno...
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[IMAGES IN CLINICAL MEDICINE] Air Bronchogram Bhupinder Natt, Yuval Raz N Engl J Med 2015; 373: 2663 A 26-year-old woman with end-stage renal disease secondary to lupus nephritis presented with a 3-day history of fever, cough, and shortness of breath, symptoms that are consistent with pneumonia. The acute respi- ratory distress syndrome (ARDS) developed, and the patient ultimately required extracorporeal membrane oxygenation (ECMO) after the failure of mechanical ven...
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Images in Clinical Medicine Cullen's and Grey Turner's Signs in Acute Pancreatitis Xavier Valette, Damien du Cheyron N Engl J Med 2015; 373: e28 A 63-year-old man with no history of alcohol abuse presented with sudden, severe epigastric pain. The serum lipase level was elevated (1380 U per liter; normal range, 22 to 51 U per liter), a finding consistent with acute pancreatitis. Abdominal ultrasonography revealed cholelithiasis without evidence of choledochol...
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Getting a Better Picture of the Correlation between Lung Function and Structure Using Electrical Impedance Tomography Claude Guerin and Inéz Frerichs American Journal of Respiratory and Critical Care Medicine, Vol. 190, No. 10 (2014), pp. 1186-1187 A 56-year-old woman with lymphangioleiomyomatosis received a single left lung transplant from a cadaveric donor on October 10, 2004. The outcome was complicated by chronic graft dysfunction with obstructive ventilatory defect a...
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Cerebral Air Embolism. A Case of Disseminated Klebsiella pneumoniae Infection Jehan Alladina, Daniela Lamas, and Josalyn Cho American Journal of Respiratory and Critical Care Medicine, Vol. 190, No. 10 (2014), pp. e60-e61. A 51-year-old man with non–insulin-dependent diabetes mellitus presented to an outside hospital with a 3-week history of weakness, polyuria, and polydipsia and was found to be in diabetic ketoacidosis. He reported a 30-pound (13.6 kg) weight loss over 3 ...
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Images in Clinical Medicine Tension Pneumoperitoneum Haytham M.A. Kaafarani, M.D., M.P.H. N Engl J Med 2015; 373: e24 DOI: 10.1056/NEJMicm150004 A 65-year-old woman who had undergone colonoscopy with removal of multiple polyps had become unresponsive at the end of the procedure and was transferred to the emergency department for evaluation. She regained consciousness but remained in distress with diaphoresis. On physical examination, the heart rate was 130 bea...
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Clinical Picture Black pleural effusion Jayakrishnan B, Dildar B, Rizavi DM, et al. Lancet 2015; 386: e7 DOI: http://dx.doi.org/10.1016/S0140-6736(14)62003-1   一名56岁男性患者因前列腺腺泡状腺癌接受治疗过程中出现右侧大量胸腔积液(图)于2014年5月就诊。尽管有大量胸腔积液,但患者仅有轻度呼吸困难,且最初因尿失禁入院治疗。胸穿显示黑色胸腔积液(图)。检查提示为渗出液,蛋白水平非常高(85 g/L;血清总蛋白56 g/L),乳酸脱氢酶和淀粉酶水平也非常高。我们在随后24小时内共引流黑色胸...
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Images in Clinical Medicine Electrical Alternans with Pericardial Tamponade Waqas Jehangir, Mohamed Osman N Engl J Med 2015; 373: e10 DOI:10.1056/NEJMicm1408805 一名56岁女性患者有6年的II期左侧乳腺癌病史,患者因进行性呼吸困难及乏力就诊。体格检查发现低血压、心动过速、颈静脉充盈、奇脉且心音遥远;血压63/44 mmHg,心率110 bpm。床旁胸片显示水瓶征(前位胸片心影变圆变大,类似水瓶),提示心包积液(图A)。经胸心脏超声检查显示大量心包积液,心脏呈前后摆动(视频),舒张末右心房及左心房...
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Mesenteric Ischemia Mimicking ST-Segment Elevation Myocardial Infarction Yen-Ting Yeh, Chung-Ming Tu, Yen-Wen Wu N Engl J Med 2015; 373: 780-781 DOI: 10.1056/NEJMc1506103   致编辑To the Editor: 一名61岁男性患者因呕吐及水样便2天,上腹部疼痛3个小时到急诊就诊。患者有7年高血压、糖尿病和高脂血症病史。就诊时,血压77/53 mmHg,脉搏92 bpm,体温35.5°C。体检发现,腹部平软没有腹膜炎体征。ECG显示下壁导联Q波形成伴ST段抬高(图1A)。诊断为下壁ST段抬高型心梗(STEMI)。急诊冠状动脉造影发...
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