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...

IMAGES IN CLINICAL MEDICINE Cerebral Cystic Echinococcosis Sumit Thakar, Akhil Sunil N Engl J Med 2023; 388:e10DOI: 10.1056/NEJMicm2208104 A previously healthy 14-year-old boy who lived on a farm presented with a 1-month history of episodic headaches associated with vomiting. Physical examination was notable for papilledema. Magnetic resonance imaging of the head showed a multiloculated cyst measuring 6.0 cm by 6.2 cm by 5.8 cm in the right temporoparietal...

IMAGES IN CLINICAL MEDICINE Cerebral Alveolar Echinococcosis Hu Ju, Chuanchuan Liu N Engl J Med 2023; 388:453DOI: 10.1056/NEJMicm2202196 A 17-year-old boy presented to the emergency department with a 3-week history of dizziness, headache, and weakness of the right leg. Neurologic examination was notable for 4/5 strength in the right lower leg. Computed tomography (CT) of the head revealed ring-enhancing lesions in the frontal lobe and basal ganglia on the ...

IMAGES IN CLINICAL MEDICINE Splenic Tuberculosis Chung-Yen Chen, Po-Jen Yang N Engl J Med January 21, 2023DOI: 10.1056/NEJMicm2206174 A 29-year-old man with human immunodeficiency virus (HIV) infection presented to the emergency department with a 2-week history of abdominal pain on the left side. Six months before presentation, he had received a diagnosis of HIV infection and non–drug-resistant pulmonary tuberculosis, for which antiretroviral and four-drug...

IMAGES IN CLINICAL MEDICINE Mercury Poisoning Yunying Feng, Fengdan Wan A previously healthy 25-year-old man presented to the general medicine clinic with a 3-month history of worsening fatigue, nausea, and dry cough. One week before the onset of his symptoms, he had injected 4 ml of elemental mercury intravenously as a folk remedy for tinea cruris. Conjunctival pallor was observed on physical examination. Laboratory studies showed a hemoglobin level of 6.5 g...

IMAGES IN CLINICAL MEDICINE Seat-Belt Sign and Seat-Belt Aorta Yuita Fukuyama, Tomokazu Motomura N Engl J Med November 5, 2022DOI: 10.1056/NEJMicm2204183 A 53-year-old woman presented to the emergency department with abdominal pain after being involved in a head-on motor vehicle collision in which she had been a driver and had been wearing a seat belt. Examination revealed decreased breath sounds in the right lung field, diffuse tenderness on palpation of the ...