IMAGES IN CLINICAL MEDICINE Intestinal Tuberculosis Luis F. Oñate-Ocaña, Lizeth Pérez-Díaz N Engl J Med 2022; 386:e30DOI: 10.1056/NEJMicm2114345 A 36-year-old woman presented to the emergency department with a 1-day history of severe abdominal pain and a 2-week history of fever and cough. She had no known medical history and worked as a physician. On physical examination, diffuse, severe abdominal tenderness with rebound and guarding was observed. Computed...

IMAGES IN CLINICAL MEDICINE Page Kidneys Adam Min, Noah Ditkofsky N Engl J Med 2022; 386:673DOI: 10.1056/NEJMicm2114692 A 21-year-old woman presented to the emergency department with a 6-week history of abdominal pain and constipation. Her blood pressure was 162/108 mm Hg. She had a history of Hirschsprung’s disease and had undergone a partial colectomy and pull-through procedure during infancy. She had no history of hypertension or renal disease and repor...

JAMA Clinical Challenge March 21, 2022 Fever, Hypotension, and a Worsening Necrotic Wound Danielle M. Peterson, William E. Damsky, Matthew D. Vesely JAMA. Published online March 21, 2022. doi:10.1001/jama.2022.2806 Case On the day of giving birth via a normal vaginal delivery, a healthy woman in her 20s developed painful swelling on her right thigh, at the site of a methergine injection administered 1 day prior. ...

Choosing Wisely® For Critical Care Daily Care Rounding Checklist First published in March 2022, this checklist provides a structured approach to maximize integration of evidence-based practices, avoid waste, and deliver safe, high-value critical care.

IMAGES IN CLINICAL MEDICINE Cholesterol Embolization Syndrome after Carotid-Artery Stenting Wei Wang, Jifu Cai N Engl J Med 2022; 386:1265DOI: 10.1056/NEJMicm2114022 A 63-year-old man had purplish discoloration of the face develop after he underwent stenting and balloon dilation of the left common carotid artery. Shivering, sweating, and confusion developed immediately after artery dilation, along with a left gaze preference, dysarthria, and hemiparesis on...

IMAGES IN CLINICAL MEDICINE Radiographic Evolution of Presumed Septic Pulmonary Emboli Zarah Haleem, Jeremy D. Gradon N Engl J Med 2022; 386:1452DOI: 10.1056/NEJMicm2114270 A 41-year-old woman presented to the emergency department with confusion, shortness of breath, and chest pain. She had a history of opioid use disorder and had been injecting drugs daily. Her temperature was 39.4°C, the heart rate was 146 beats per minute, and the oxygen saturation was ...

IMAGES IN CLINICAL MEDICINE Thrombectomy in Acute Ischemic Stroke David C. Lauzier, Akash P. Kansagra N Engl J Med 2022; 386:1351DOI: 10.1056/NEJMicm2116727 A 63-year-old man with atrial fibrillation, hypertension, and type 2 diabetes presented to the emergency department with weakness on the left side and difficulty speaking, both of which had begun 6 hours earlier. On examination, he had dysarthria, 0/5 strength in the left arm, and 1/5 strength in the l...

IMAGES IN CLINICAL MEDICINE Pulmonary-Artery Aneurysm with Acute Dissection Asvin M. Ganapathi, Curt J. Daniels N Engl J Med 2022; 386:273DOI: 10.1056/NEJMicm2104225 A 35-year-old woman with idiopathic pulmonary arterial hypertension presented to the emergency department with a 1-day history of chest pain. She had been undergoing evaluation for lung transplantation and was known to have a 12-cm pulmonary-artery aneurysm that had been enlarging over the pre...

Why Should We Be Measuring Ionized Magnesium? Magnesium in the Human Body Magnesium (Mg) is the 4th most abundant cation in the human body. The majority of it is found intracellularly, more than half in bone, about a third in muscle, and the remaining in soft tissue and extracellular fluid (Figure 1). Magnesium is found in the diet from a variety of sources: green leafy vegetables (Mg is found in chlorophyll), nuts and seeds, fruits, yogurt, and unrefined grains suc...

JAMA Diagnostic Test Interpretation September 17, 2021 Interpreting SARS-CoV-2 Test Results KC Coffey, Daniel J. Diekema, Daniel J. Morgan, et al JAMA. Published online September 17, 2021. doi:10.1001/jama.2021.16146 Case A53-year-old woman was referred to the gastroenterology clinic for endoscopy because of a submucosal gastric nodule. She had not received a COVID-19 vaccination and lived in Maryland, which...