IMAGES IN CLINICAL MEDICINE Exogenous Lipoid Pneumonia Taichi Kaneko, Ryota Otoshi N Engl J Med 2025;392: e12 DOI: 10.1056/NEJMicm2407298 A 38-year-old woman was referred to the pulmonary clinic for evaluation of an opacity in the right lower lobe seen on chest radiography. She had no respiratory symptoms but did report a 6-year history of disordered eating in which she would consume large amounts of salad oil and then induce vomiting. On physical exami...

IMAGES IN CLINICAL MEDICINE Westermark’s Sign and Palla’s Sign in Pulmonary Embolism Yuichiro Shimoyama, Yoshitaka Tomoda N Engl J Med 2025;392: e2 A 90-year-old man with atrial fibrillation and dementia presented to the hospital with sudden onset of dyspnea that had begun 1 hour earlier. Before admission, he had not been taking anticoagulation therapy on the basis of discussions of his preferences with his primary care physician. Physical examination was ...

Teachable Moment  Less Is More October 21, 2024 The Harm of Inappropriate Central Line Blood Cultures in Clinical Practice Alexandra N. Fuher, Heather Young, Mark E. Mikkelsen JAMA Intern Med. Published online October 21, 2024. doi:10.1001/jamainternmed.2024.5344 A57-year-old man with end-stage kidney disease who was receiving hemodialysis through a tunneled central venous catheter presented to the emergency department with severe hyperkal...

IMAGES IN CLINICAL MEDICINE Eiffel-by-Night Sign Kundian Guo, Zhen Hong N Engl J Med 2024;391:1936 DOI: 10.1056/NEJMicm2408573 A 50-year-old man presented with a 1-year history of progressive headaches and nausea. On physical examination, neck stiffness and dysmetria in both arms on finger-to-nose testing were noted. Results of a lumbar puncture revealed an opening pressure of 31 cm of water (reference range, 7 to 20), and cerebrospinal fluid studies we...

No ventilation, no ARDS: insights from four-dimensional computed tomography as dynamic imaging Okamura, G., Nishiyama, S., Ono, S. et al. Intensive Care Med (2024). https://doi.org/10.1007/s00134-024-07643-w A 63-year-old male, who was in remission from myelodysplastic syndrome after bone marrow transplantation, had previously undergone partial resection of the right upper lobe due to pulmonary aspergillosis. Over a year later, he presented with dyspnea and subse...

IMAGES IN CLINICAL MEDICINE Flail Chest Zhi Hu, Biao Wang N Engl J Med 2024;391: e22 A 59-year-old man with a history of chronic obstructive pulmonary disease was brought to the emergency department after a motor vehicle collision. The steering wheel of the patient’s car had struck his chest after the airbag had not deployed. His heart rate was 99 beats per minute, blood pressure 123/84 mm Hg, respiratory rate 30 breaths per minute, and oxygen saturation 9...

IMAGES IN CLINICAL MEDICINE Alpha1-Antitrypsin Deficiency José Maria Hernández Pérez N Engl J Med Published August 17, 2024 DOI: 10.1056/NEJMicm2403183 A 60-year-old woman with a 15-pack-year smoking history was referred to the pulmonology clinic owing to several years of dyspnea on exertion. She had quit smoking at 43 years of age. Her father had died from emphysema. Her oxygen saturation was 93% while she was breathing ambient air. Physical examinatio...

Imaging in Intensive Care Medicine Published: 19 June 2024 18F-fluorodeoxyglucose positron emission tomography/computed tomography differentiates between pneumonia and atelectasis in a mechanically ventilated patient Intensive Care Med (2024). https://doi.org/10.1007/s00134-024-07505-5 Differentiation between atelectasis and pneumonia in critically-ill patients can be challenging on regular computed tomography (CT). In this image the additional value of...

IMAGES IN CLINICAL MEDICINE Necrotizing Soft-Tissue and Retropharyngeal Space Infections and Mediastinitis Martin A. Gomez, Beatriz Mejia N Engl J Med 2024;391: e5 DOI: 10.1056/NEJMicm2312959 A 50-year-old man with no known medical history presented to the emergency department with a 3-day history of tooth and jaw pain on the left side, fever, and shortness of breath. He lived in a rural area and had never visited a physician or dentist. Physical examin...

A Coin in the Airway Victor Bor-Chang Hsue, Vijay Patel N Engl J Med 2024; 390: e33 DOI: 10.1056/NEJMicm2312266 A healthy 14-year-old boy presented to the emergency department with a 6-hour history of hoarseness and difficulty swallowing after having accidentally swallowed a coin. On physical examination, the patient was breathing comfortably without stridor or drooling. Radiographs of the chest (Panel A, posteroanterior view) and ...