Tension Pneumoperitoneum Associated with Nasopharyngeal Catheter Oxygen Delivery during Bronchoscopy Karim El-Kersh, Hala Karnib Am J Respir Crit Care Med 2017 Published on 29-June-2017 as 10.1164/rccm.201701-0181IM A 61-year-old female with chronic lymphocytic leukemia was undergoing bronchoscopy with bronchoalveolar lavage. The patient never smoked and she did not have any underlying chronic gastric disease. The bronchoscopy was performed in supine position under conscio...

Images in Clinical Medicine Calcium Oxalate Crystals in Ethylene Glycol Toxicity Mohamad Hanouneh, Teresa K. Chen N Engl J Med 2017; 377: 1467 An 80-year-old man with a remote history of alcohol-use disorder presented to the emergency department with altered mental status after a fall at home. He was somnolent and unable to provide any further history. Serum studies revealed a creatinine level of 2.4 mg per deciliter (212 μmol per liter; reference range, 0....

Images in Clinical Medicine Pulmonary Foreign-Body Granulomatosis Dustin A. Staloch, J. Stephen Hedley N Engl J Med 2017; 377: 1273 A 31-year-old woman who was receiving long-term total parenteral nutrition after having undergone Roux-en-Y gastric bypass that was complicated by small-bowel resection presented to the pulmonology clinic with exertional dyspnea that had progressed over the course of 1 year. She had normal oxygen saturation while breathing ambient air and was...

Aberrant Right Subclavian Artery on EBUS Nicholas M. Mark, David K. Madtes Am J Respir Crit Care Med 2017 Published on 06-July-2017 as 10.1164/rccm.201704-0706IM A 70 year old man underwent bronchoscopy under general anesthesia for biopsy of mediastinal adenopathy due to suspected lymphoma. The airways appeared normal, however on endobronchial ultrasound (EBUS) examination, a thick walled pulsatile mass posterior to the trachea was visualized (A). Doppler ultrasound (B) re...

IMAGES IN CLINICAL MEDICINE Eosinophilic Bronchitis Yanhong Ren, M.D., Ph.D., and Huaping Dai, M.D. N Engl J Med 2017; 377:873 DOI: 10.1056/NEJMicm1616156 A 43-year-old woman presented with an 8-month history of progressively worsening nonproductive cough. She had been treated with antibiotic agents for presumed bronchitis, but her cough continued to worsen. Her vital signs were normal, the pulmonary examination was notable for wheezing in both lungs, and the white-cell c...

Imaging in Intensive Care Medicine Fat embolism syndrome Anselmo Caricato, Giovanni Russo, Daniele Guerino Biasucci, Maria Giuseppina Annetta Intensive Care Med 2017; 43: 1411-1412 A 19-year-old man was admitted to our emergency department after a road accident. He presented with bilateral femoral fractures that were promptly treated with external fixators. After surgery, he was monitored in ICU. Twenty-four hours after admission, fever, tachycardia, dyspnea, and hypoxia a...

Images in Clinical Medicine Left-Middle-Lobe Pneumonia Ling Yuan Kong, Yves Longtin N Engl J Med 2017; 377: e8 DOI:10.1056/NEJMicm1700661 A 34-year-old man presented to the emergency department with a 5-day history of fever, cough, and dyspnea. He had received a diagnosis of situs inversus when he was 2 years of age, after a chest radiograph had been obtained in order to evaluate a cough. Physical examination was notable for heart sounds in the right side of his chest and...

Imaging in Intensive Care Medicine Resuscitated unconscious male: Lichtenberg’s sign lighting the way Andrew Lindford, Jyrki Vuola, Esko Kankur Intensive Care Medicine 2017; 43: 1148–1149 An intubated unconscious 18-year-old male was admitted to the trauma center with a fern-leaf erythematous pattern on his right chest and flank, a second-degree upper chest burn, and a deep full-thickness occipital scalp burn (Fig. 1a). Earlier in the day his military unit had completed...

Chest X-Rays: 16 Subtle But Key Findings You Need to Know Lars Grimm, MD, MHS | August 2, 2017 The chest radiograph is one of the views most commonly ordered by clinicians, and it is frequently first viewed by non-radiologists. Although many disease processes are obvious at first glance on chest radiographs, clinicians must be careful not to miss more subtle findings. This image shows a solitary pulmonary nodule (circle) in the left midlung. Image courtesy of Lars Grimm, ...

Imaging in Intensive Care Medicine Echography of pneumatosis intestinalis and hepatic portal venous gas in a patient with septic shock Jiaqi Xu, Shangzhong Chen, Jing Yan, Jianjun Zhang Intensive Care Medicine 2017; 43: 1152–1153 An 88-year-old male patient was admitted to our ICU with a diagnosis of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure. During hospitalization the patient presented with abdominal pain, abdominal dist...