IMAGES IN CLINICAL MEDICINE Inhalation Injury from House Fire Smoke Juan Huang, Cheng Yang N Engl J Med 2026;394: e39 A 55-year-old man presented to the emergency department with cough, chest pain, and worsening dyspnea after being trapped in a burning house for 10 minutes. His heart rate was 120 beats per minute, his respiratory rate 30 breaths per minute, and his oxygen saturation 92% while he was receiving supplemental oxygen through a na...

Article What is the most appropriate next step in a patient with progressive subcutaneous emphysema and hemodynamic deterioration? Kimoto, K., Iwasaki, Y., Hagiwara, Y. et al Intensive Care Med (2026). https://doi.org/10.1007/s00134-026-08471-w Tension pneumomediastinum is a rare but life-threatening complication; while most cases are managed conservatively, those with tension physiology causing hemodynamic compromise require invasive decompression (Fig. 1...

Article Source control following traumatic gastric perforation : not so easy Bernard, C., Gessen, S., Gregory, J. et al Intensive Care Med (2026). https://doi.org/10.1007/s00134-026-08446-x Management of the gastric perforation and diaphragmatic rupture (Figure 1. Panels A-C) consisted in:  surgical repair left chest drainage without mediastinal drainage due to communication between the mediastinum and the right pleura, which was drained&n...

Article A misleading acute respiratory failure: when infection is not where you expect it Pequignot, B., Barraud, D., Stephan, C. et al. Intensive Care Med (2026). https://doi.org/10.1007/s00134-026-08484-5 Unusual pathogens matter: Corynebacterium spp., including Corynebacterium diphtheriae, can cause invasive infections beyond classical diphtheria, including bacteremia and prosthetic infections. Recent epidemiological and clinic...

Article Black hole sign Hayano, S., Tani, N., Toyama, Y. et al. Intensive Care Med (2026). https://doi.org/10.1007/s00134-026-08470-x Direct gram stains of peripheral blood can show gram-positive rods (Fig. 1C, arrow), and C. perfringens bacteremia can be confirmed through blood culture within 5 h of incubation. For C. perfringens sepsis accompanied by intravascular hemolytic anemia, a treatment with meropenem and clindamycin can be initiated. A Dar...

IMAGES IN CLINICAL MEDICINE Pneumocystis jirovecii Pneumonia Ke Xiao N Engl J Med 2026;394:382 DOI: 10.1056/NEJMicm2514525 A 60-year-old man with recently diagnosed human immunodeficiency virus (HIV) infection presented to the infectious diseases clinic with a 10-day history of fever, dry cough, and shortness of breath. Treatment for HIV infection had not yet been started. His respiratory rate was 32 breaths per minute, heart rate 120 bea...

Article What is your diagnosis? Severe barotrauma supported with VV-ECMO Presa Orue, A., Lasa-Berasain, P., Ruiz Lucea, J. et al. Intensive Care Med (2026). https://doi.org/10.1007/s00134-026-08472-9 Macklin effect and progression to Hamman syndrome: The Macklin effect describes a well-established pathophysiological and radiological mechanism in which air resulting from alveolar rupture dissects along the peribronchovascular sheaths and migrat...

Article What is your diagnosis? Severe barotrauma supported with VV-ECMO Presa Orue, A., Lasa-Berasain, P., Ruiz Lucea, J. et al. Intensive Care Med (2026). https://doi.org/10.1007/s00134-026-08472-9

IMAGES IN CLINICAL MEDICINE Cerebral Amyloid Angiopathy Sihui Chen, Xueping Chen N Engl J Med 2026;394:1846 DOI: 10.1056/NEJMicm2511044 An 86-year-old man presented to the neurology clinic with a 2-year history of progressive memory loss and gait instability. Recent computed tomography of the head had shown mild cerebral atrophy. Neurologic examination was notable for a slow gait with a narrow base of support, as well as moderate-to-severe cognitive imp...

IMAGES IN CLINICAL MEDICINE Intraosseous Abscess from Subacute Osteomyelitis Haijian Li N Engl J Med 2026;394:1529 DOI: 10.1056/NEJMicm2514540 A previously healthy 16-year-old girl presented to the orthopedic clinic with a 1-month history of left ankle pain and an 11-day history of fever. The physical examination was notable for generalized tenderness to palpation of the left ankle, along with a limited active and passive range of motion. Plain radiogra...