IMAGES IN CLINICAL MEDICINE Uremic Frost Muzamil Ahmad Wani, Zeeza Hussain Shah N Engl J Med 2025;393:1327 DOI: 10.1056/NEJMicm2507714 A 52-year-old woman with hypertension presented to the hospital with a 1-month history of fatigue, as well as 6 days of vomiting and 1 day of confusion. Over the past 20 years, she had not received regular treatment for hypertension. Physical examination was notable for pallor of the conjunctiva and o...

Imaging in Intensive Care Medicine Hypervirulent Klebsiella pneumoniae: watch the eyes Yan Wang, He Zhou, Meiling Ding, et al Intensive Care Med (2025). https://doi.org/10.1007/s00134-025-08109-3 Imaging studies (Fig. 1, Panels A–E) revealed a solitary lung abscess, a large hepatic abscess, and endophthalmitis characterized by flocculent vitreous opacities. Liver puncture drainage was performed. Microbiological cultures (Panel F) from blood, liver aspi...

Imaging in Intensive Care Medicine "Air in the water"—the hydropoint sign Eleni Soilemezi, Petros Morfesis, Vassiliki Birmpa, et al Intensive Care Med 2025; 51: 1721–1723 A 30-year-old female patient was admitted in ICU due to community-acquired pneumonia causing bilateral lung infiltrations and severe hypoxemia requiring mechanical ventilation. An episode of rapid desaturation (SpO2 87% despite increased FiO2 to 100%) triggered a new lung ultrasound assessmen...

IMAGES IN CLINICAL MEDICINE Snowman Sign in Pituitary Macroadenoma Yuwei Zhou, Wei Weng N Engl J Med 2025;393:699 DOI: 10.1056/NEJMicm2503820 A previously healthy 47-year-old woman presented to the neurology clinic with a 1-month history of worsening headaches associated with blurry vision, galactorrhea, and irregular menstrual cycles. Physical examination was notable for reduced visual acuity of 20/50 in both eyes, with normal visual fields and extraoc...

IMAGES IN CLINICAL MEDICINE Incarcerated Femoral Hernia Pratyaksha Rana, Hit Jivani N Engl J Med 2025;393: e2 DOI: 10.1056/NEJMicm2500535 A 77-year-old woman presented to the emergency department with a 2-day history of abdominal pain, nausea, and vomiting. On physical examination, abdominal distention with tenderness was present in the left lower quadrant. Computed tomography of the abdomen revealed herniation of a loop of ileum on the left side (Panel...

IMAGES IN CLINICAL MEDICINE Diffuse Alveolar Hemorrhage in ANCA-Associated Vasculitis Irene S. Lee N Engl J Med 2025;393:72 DOI: 10.1056/NEJMicm2416576 A 57-year-old man with hypertension presented to the emergency department with a 2-week history of worsening shortness of breath. His oxygen saturation was 68% while he was breathing ambient air. He was confused and unable to speak. Physical examination was notable for diffuse crackles in both lungs. Tra...

JAMA Insights  March 5, 2025 Cardiac CT Calcium Score Peter Glynn, Sadiya S. Khan, Philip Greenland JAMA. 2025;333(16):1447-1448. doi:10.1001/jama.2025.0610 What Is Coronary Artery Calcium and the Cardiac Computed Tomography Calcium Score? Coronary artery plaque can consist of calcified and/or noncalcified material. Computed tomography (CT) can detect and measure coronary artery calcium (CAC) levels in calcified plaque,...

Viewpoint  Less Is More June 9, 2025 The Impact of Definitions of Disease on Overdiagnosis Kari A. O. Tikkinen, Alex L. E. Halme, Gordon H. Guyatt, et al JAMA Intern Med. Published online June 9, 2025. doi:10.1001/jamainternmed.2025.1727 The concept and definition of disease influences both clinical practice and public health. The World Health Organization has defined health but failed to define disease. ...

Viewpoint  May 27, 2025 Optimizing Safety for Patients Transferred From Intensive Care Units to General Medical Wards: A SIMPLER Approach Donald A. Redelmeier, Barbara Haas, William K. Silverstein JAMA Intern Med. Published online May 27, 2025. doi:10.1001/jamainternmed.2025.1497 Most patients admitted to an intensive care unit (ICU) survive.1 A patient, of course, does not return to health instantly even when vasopressors, ventilators, ...

Viewpoint  May 5, 2025 Nitrites for Urinary Tract Infection—Time to Say Goodbye? Jackson J. Stewart, Joan L. Robinson, Justin Z. Chen JAMA Intern Med. Published online May 5, 2025. doi:10.1001/jamainternmed.2025.0973 The urinary nitrite test is a long-standing component of the dipstick portion of the urinalysis, but it is time to question its relevance in distinguishing urinary tract infection (UTI) from asymptomatic bacteriuria, and thus in ...