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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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Images in Clinical Medicine Central Pontine Myelinolysis Aniket N. Tavare, F.R.C.R., Diane Murray, F.R.C.R. N Engl J Med 2016; 374: e8 A 35-year-old man presented with acute alcoholic hepatitis and encephalopathy. He was hyponatremic, with a sodium level of 119 mmol per liter. Over the next 5 days his clinical condition improved with supportive treatment, which included lactulose and intravenous vitamins and the careful administration of normal saline for hypo...
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Images in Clinical Medicine Spontaneous Retropharyngeal Hematoma Noah Ditkofsky, Tarek Hanna N Engl J Med 2016; 374: e3 DOI: 10.1056/NEJMicm1505596 A 56-year-old man presented to the emergency department with a 5-hour history of throat swelling and pain and difficulty breathing that was exacerbated by supine positioning; he had not had any obvious ante- cedent trauma. His medical history included prostate cancer, hypertension, hyperlipidemia, deep-vein thrombosis, and ...
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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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