IMAGES IN CLINICAL MEDICINE Aspiration of a Chicken Bone Huey Ming Seah, Marcela Mautone N Engl J Med 2018; 378:e25 DOI: 10.1056/NEJMicm1713423 A 78-year-old man presented to the emergency department with stridor, shortness of breath, and fever (38.1°C). Five days earlier, he had come to the emergency department with the sensation of having a foreign body in his throat, approximately an hour after a choking episode that had occurred while he was eating chicken. At that ti...

IMAGES IN CLINICAL MEDICINE Raindrop Skull Fabio Solis, Cesar Gonzalez N Engl J Med 2018; 378:1930 DOI: 10.1056/NEJMicm1714471 A 46-year-old man presented to the emergency department with a 1-month history of fatigue, shortness of breath, and low back pain and report of a weight loss of 30 kg over the previous 10 months. On physical examination, his conjunctiva and palms were pale. Laboratory evaluation revealed a hemoglobin level of 4.9 g per deciliter (reference range, ...

IMAGES IN CLINICAL MEDICINE Colon Cutoff Sign Po-Yi Chen, M.D. N Engl J Med 2018; 378:1621 DOI: 10.1056/NEJMicm1714270 A 74-year-old woman presented to the emergency department with a 3-day history of lower abdominal pain, nausea, and vomiting. She had been unable to pass any stool for 1 week and reported having had small-caliber stool during the previous 6 months. On physical examination, bowel sounds were reduced, and the patient had periumbilical tenderness. Laboratory...

IMAGES IN CLINICAL MEDICINE Electrocardiographic Changes in Hypothermia Eleftheria Kampouri, M.D., and Julien Vaucher, M.D. N Engl J Med 2018; 378:460 DOI: 10.1056/NEJMicm1704534 A 76-year-old woman with a history of dementia and coronary heart disease was brought to the emergency department after she had been found lying outdoors for an undetermined period; her core body temperature was 26°C (78.8°F) at presentation. An electrocardiogram showed prominent Osborn waves, al...

IMAGES IN CLINICAL MEDICINE Phlegmasia Cerulea Dolens with Compartment Syndrome Hsin-Ti Lai, and Shu-Hung Huang N Engl J Med 2018; 378:658 DOI: 10.1056/NEJMicm1704996 An 81-year-old man with hypertension presented to the emergency department with pain and swelling of the left thigh and lower leg that had developed during the previous several hours. He had no history of recent surgery or trauma and no known personal or family history of clotting disorders. The left lower l...

Images in Clinical Medicine Pneumomediastinum Associated with Influenza A Infection Christopher T. Mansbridge, Matthew Inada-Kim N Engl J Med 2018; 378: e1 DOI:10.1056/NEJMicm1702849   A  previously healthy 33-year-old man presented to the emergency department with a 10-day history of lethargy and feeling unwell. His temperature was 38.3°C, and he had tachycardia, with an oxygen saturation of 85% while breathing 15 liters of oxygen per minute through a nonrebreather ...

Images in Clinical Medicine Ventriculoperitoneal-Shunt Placement for Normal-Pressure Hydrocephalus Mahmoud A. AbdelRazek, Nagagopal Venna N Engl J Med 2017; 377: e35 DOI:10.1056/NEJMicm1701226 A 70-year-old woman presented to the neurology clinic with a 2-year history of gait disturbance, cognitive impairment, and urinary incontinence. Examination revealed a Mini–Mental State Examination (MMSE) score of 12 (on a scale of 0 to 30, with higher scores representing better per...

Images in Clinical Medicine Talaromyces marneffei Infection Zixiang Si,  Jianjun Qiao N Engl J Med 2017; 377: 2580 DOI:10.1056/NEJMicm1704164 A  29-year-old man presented to an outpatient clinic with a 2-month history of fever, cough, dyspnea, and weight loss, as well as skin lesions that had developed on his face, neck, trunk, arms, and legs over a period of 2 weeks. Physical examination revealed extensive umbilicated papules (Panel A). A biopsy specimen obtained from a ...

IMAGES IN CLINICAL MEDICINE Pneumatosis Cystoides Intestinalis Yuusaku Sugihara, M.D., Ph.D., and Hiroyuki Okada, M.D., Ph.D. N Engl J Med 2017; 377:2266 DOI: 10.1056/NEJMicm1701357 A 48-year-old woman presented to an outpatient clinic with a several-month history of abdominal fullness. She also had a history of eosinophilic pneumonia, which had been treated continuously with glucocorticoids for 7 years. On examination, her abdomen was distended but soft, with normal bowe...

Images in Clinical Medicine Falciform Ligament Sign Po-Chen Chou, Yu-Jang Su N Engl J Med 2017; 377: e28 DOI:10.1056/NEJMicm1613914 An 87-year-old woman with a history of hypertension and peptic ulcer disease presented to the emergency department with a 3-day history of abdominal distention, pain in the epigastrium, and watery diarrhea. She had hypotension (blood pressure of 78/49 mm Hg), and diffuse abdominal tenderness with guarding was observed on physical examination. ...