Rapid-Onset Cystic Bronchiectasis in a Mechanically Ventilated Patient with COVID-19 Michael Gilmartin ,  Ahmad Basirat ,  Conor Barry , et al Am J Respir Crit Care Med Vol 205, Iss 6, pp 721–722, Mar 15, 2022 A 40-year-old man presented to the ICU after intubation due to respiratory failure secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonitis. Past medical history revealed a history of intravenous drug use (heroin). Early blood a...

IMAGES IN CLINICAL MEDICINE Primary Cutaneous Blastomycosis Albert Alhatem, Kristin C. Smith N Engl J Med 2022; 386:e49DOI: 10.1056/NEJMicm2116178 A 53-year-old man presented to the dermatology clinic with a 4-month history of red, raised, itchy skin lesions on his left lower back and buttock. He had no known medical history and reported no constitutional or respiratory symptoms. He worked as a landscaper, often sustaining skin abrasions while trimming tre...

IMAGES IN CLINICAL MEDICINE Pneumatosis Intestinalis in Necrotizing Enterocolitis Lorraine Tong, Yu-Tang Chang N Engl J Med 2022; 386:1070DOI: 10.1056/NEJMicm2115830 An 11-day-old boy born at 39 weeks of gestation presented to the emergency department with watery diarrhea, bilious emesis, progressively worsening abdominal distention, and shock. There had been no complications during his birth, and he had been growing appropriately while receiving breast mi...

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. Despite 3 days of treatment wi...

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 ...