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...

IMAGES IN CLINICAL MEDICINE Mobile Aortic Thrombi Ville Sallinen, M.D., Ph.D., and Pirkka Vikatmaa, M.D., Ph.D. N Engl J Med 2017; 377:e2 July 13, 2017 DOI: 10.1056/NEJMicm1702263 An 85-year-old woman with essential thrombocytosis, coronary artery disease, and a remote history of venous thromboembolism presented with abdominal pain, fever, vomiting, and diarrhea. Physical examination revealed tenderness and guarding in the lower abdomen. Laboratory results showed a white-...

Critical Chest Radiographs: Can't-Miss Diagnoses Lars Grimm, MD, MHS | April 19, 2017 Many chest radiographs are first viewed by non-radiologists, who must be able to quickly recognize critical findings that identify patients who need emergent care. This image depicts a massive pneumoperitoneum following surgery. Image courtesy of Medscape. A pneumothorax occurs when air fills the space between the parietal and visceral pleura. A primary spontaneous pneumothorax occurs i...

Diffuse Subcutaneous Emphysema Following Tracheal Perforation Andrew Keenan, William Browne, Maneesh Bhargava AJRCCM Articles in Press. Published on 17-March-2017 as 10.1164/rccm.201611-2394IM     A 77-year-old woman without prior lung disease experienced a respiratory arrest at home requiring an emergency medical response. A King LT TM supraglottic airway was placed as endotracheal intubation was unsuccessful. She developed massive soft tissue swelling during ...

Images in Clinical Medicine Incidental Finding of Oleothorax Abhilash Koratala, Vikrampal Bhatti. N Engl J Med 2017; 376; e21 DOI:10.1056/NEJMicm1609176   An 86-year-old woman with hypertension who had been treated for pulmonary tuberculosis in the 1950s presented with burning chest and epigastric pain. She had no respiratory symptoms. After acute coronary syndrome was ruled out, she was treated for gastroesophageal reflux, which relieved her symptoms. A chest radiog...

Effects of Variable Pressure Support Ventilation on Regional Homogeneity and Aeration Tommaso Mauri, Marta Lazzeri, Alfio Bronco, et al. Am J Respir Crit Care Med 2017; 195: e27-e28 Figure 1.Physiologic effects of variable pressure support assessed by electrical impedance tomography. After application of variable pressure support, distribution of tidal ventilation within the patient’s chest became more homogeneous (A and B) and was associated with improved lung aerati...

Lobar Necrosis from Pulmonary Embolism Ramiro Fernandez ,  Jonathan M. Tomasko ,  Daphne Edgren, et al Am J Respir Crit Care Med 2017; 195: 685-686 A 63-year-old male heart transplant recipient with recurrent lower extremity deep vein thrombosis, receiving warfarin, with chronically reduced glomerular filtration rate (30 ml/min), presented with worsening cough and dyspnea. Laboratory testing revealed normal blood cell counts, mildly elevated C-reactive protein, and in...

Images in Clinical Medicine Empyema Necessitatis Ronaldo A. Gismondi, M.D., Ph.D. Luiz F.F. de Souza, M.D. N Engl J Med 2017; 376: e13 DOI: 10.1056/NEJMicm1608914 A 40-year-old man presented with a 3-month history of fever, weight loss, dyspnea, and cough. Physical examination revealed a tender, bulging anterior thoracic mass and a small ulcerative lesion that was inferomedial to the right nipple (Panel A). Computed tomographic scans showed a pleural effusion (Pa...