IMAGES IN CLINICAL MEDICINE Venous Thoracic Outlet Syndrome Sang Jun Park, Hyun Jin Cho N Engl J Med 2023; 389:e32DOI: 10.1056/NEJMicm2301198 A 36-year-old woman was referred to the thoracic surgery clinic after she had presented with a 3-week history of swelling and bluish discoloration of the left arm and hand that occurred when she raised her arms (Panel A). The symptoms started after she had spent 10 days typing at a desk. Computed tomography of the ch...

Abdominal Pain and Hypotension in a 70-Year-Old Woman Educational ObjectiveBased on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis. Case A 70-year-old woman with hypertension, atrial fibrillation, congestive heart failure, and gallstones presented to the emergency department with 3 days of nausea, vomiting, and abdominal pain. She reported no hematemesis, hematochezia, or melena and had no history of abdominal s...

Abdominal Pain and Hypotension in a 70-Year-Old Woman Educational ObjectiveBased on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis. Case A 70-year-old woman with hypertension, atrial fibrillation, congestive heart failure, and gallstones presented to the emergency department with 3 days of nausea, vomiting, and abdominal pain. She reported no hematemesis, hematochezia, or melena and had no history of abdominal s...

IMAGES IN CLINICAL MEDICINE Superior Mesenteric Artery Syndrome Thibault Kerdiles, Julien Gras N Engl J Med 2023; 389:359DOI: 10.1056/NEJMicm2213146 A 26-year-old man from Somalia presented to the emergency department with a 5-month history of dry cough, night sweats, and unintentional weight loss of 18 kg. During this period, epigastric pain and episodes of postprandial vomiting had also developed. His body-mass index (the weight in kilograms divided by t...

Challenges in Clinical Electrocardiography  March 13, 2023 Computer-Estimated Heart Rate vs True Heart Rate—Be Aware of the Software Laszlo Littmann JAMA Intern Med. Published online March 13, 2023. doi:10.1001/jamainternmed.2022.6613 Case Presentation Apatient in their 60s was admitted to the intensive care unit for gastrointestinal bleeding and shock associated with liver cirrhosis, portal hypertension, and ruptured esophageal varices. E...

IMAGES IN CLINICAL MEDICINE Periorbital Edema in Dermatomyositis Caoilfhionn M. Connolly, Lisa Christopher-Stine N Engl J Med 2023; 388:e52DOI: 10.1056/NEJMicm2210861 A 61-year-old woman presented to the rheumatology clinic with a 6-month history of periorbital swelling and shoulder weakness. She reported no dyspnea, cough, or joint pain. The physical examination was notable for erythema of the upper and lower eyelids and substantial periorbital edema (Pan...

IMAGES IN CLINICAL MEDICINE Coffee Bean Sign in Cecal Volvulus Pascal Gavriilidis, Francisco Reyes Milian N Engl J Med 2023; 388:1415DOI: 10.1056/NEJMicm2210796 An 87-year-old man with chronic kidney disease, hypertension, and atrial fibrillation presented to the emergency department on a remote South Atlantic island where he resided with a 3-day history of constipation and lower abdominal pain. The patient’s body temperature was 39.2°C, the heart rate was...

IMAGES IN CLINICAL MEDICINE “Hairy Kidney” in Erdheim–Chester Disease Nityasree Srialluri, Mohamed G. Atta N Engl J Med 2023; 388:925DOI: 10.1056/NEJMicm2208776 A 62-year-old man undergoing abdominal ultrasonography for the evaluation of gallstones was found to have a retroperitoneal mass. A physical examination and the results of routine laboratory studies, including tests of renal function, were normal. A computed tomographic (CT) urogram showed soft-tis...

IMAGES IN CLINICAL MEDICINE Pseudothrombocytosis Konstantinos Liapis, Stavros Papadakis N Engl J Med 2023; 388:746DOI: 10.1056/NEJMicm2209299 An 80-year-old woman who had been admitted to the intensive care unit (ICU) with severe burns was noted to have an elevated platelet count. She had been rescued from a house fire and admitted to the ICU for the management of second- and third-degree burns involving 55% of her body-surface area. On presentation, labor...

IMAGES IN CLINICAL MEDICINE Bilothorax Yu Kurahara, Ikue Nagayama N Engl J Med 2023; 388:e17DOI: 10.1056/NEJMicm2206943 A 77-year-old man with metastatic lung adenocarcinoma presented to the emergency department with a 2-week history of dyspnea. Examination was notable for reduced breath sounds at the right lung base. A chest radiograph showed a pleural effusion on the right side (Panel A). An abdominal ultrasound image showed previously known liver metast...