IMAGES IN CLINICAL MEDICINE Incarcerated Femoral Hernia Pratyaksha Rana, Hit Jivani N Engl J Med 2025;393: e2 DOI: 10.1056/NEJMicm2500535 A 77-year-old woman presented to the emergency department with a 2-day history of abdominal pain, nausea, and vomiting. On physical examination, abdominal distention with tenderness was present in the left lower quadrant. Computed tomography of the abdomen revealed herniation of a loop of ileum on the left side (Panel...

IMAGES IN CLINICAL MEDICINE Diffuse Alveolar Hemorrhage in ANCA-Associated Vasculitis Irene S. Lee N Engl J Med 2025;393:72 DOI: 10.1056/NEJMicm2416576 A 57-year-old man with hypertension presented to the emergency department with a 2-week history of worsening shortness of breath. His oxygen saturation was 68% while he was breathing ambient air. He was confused and unable to speak. Physical examination was notable for diffuse crackles in both lungs. Tra...

IMAGES IN CLINICAL MEDICINE Round Pneumonia Jhon Camacho-Cruz, Daniela Guerrero-Sanchez N Engl J Med 2025;392: e39 A previously healthy 4-year-old girl who was up to date on routine vaccinations presented to the emergency department with a 3-day history of dry cough and fever. On physical examination, intercostal retractions and decreased breath sounds over the left lung were observed. Laboratory studies were notable for neutrophilic leukocytosis. A chest ...

JAMA Insights  March 17, 2025 Point-of-Care Ultrasound in Sepsis and Septic Shock Timothy B. Kaselitz, Christopher W. Seymour JAMA. Published online March 17, 2025. doi:10.1001/jama.2025.1983 Point-of-care ultrasound (POCUS) is a portable imaging tool used to guide clinicians in the rapid assessment of patients at the bedside. Because POCUS is noninvasive, radiation sparing, inexpensive, and allows for repeat examinations with evolving clinic...

IMAGES IN CLINICAL MEDICINE Lymphoid Interstitial Pneumonia Furkan Ufuk N Engl J Med 2025;392:806 DOI: 10.1056/NEJMicm2411756 A previously healthy 37-year-old man presented to the pulmonary clinic with a 10-month history of dry cough, fatigue, and dry mouth. He was a lifelong nonsmoker. On physical examination, crackles were heard at both lung bases. The oral mucosa and conjunctivae were dry, and dental caries were present. A chest radiograph show...

IMAGES IN CLINICAL MEDICINE Exogenous Lipoid Pneumonia Taichi Kaneko, Ryota Otoshi N Engl J Med 2025;392: e12 DOI: 10.1056/NEJMicm2407298 A 38-year-old woman was referred to the pulmonary clinic for evaluation of an opacity in the right lower lobe seen on chest radiography. She had no respiratory symptoms but did report a 6-year history of disordered eating in which she would consume large amounts of salad oil and then induce vomiting. On physical exami...

IMAGES IN CLINICAL MEDICINE Westermark’s Sign and Palla’s Sign in Pulmonary Embolism Yuichiro Shimoyama, Yoshitaka Tomoda N Engl J Med 2025;392: e2 A 90-year-old man with atrial fibrillation and dementia presented to the hospital with sudden onset of dyspnea that had begun 1 hour earlier. Before admission, he had not been taking anticoagulation therapy on the basis of discussions of his preferences with his primary care physician. Physical examination was ...

IMAGES IN CLINICAL MEDICINE Eiffel-by-Night Sign Kundian Guo, Zhen Hong N Engl J Med 2024;391:1936 DOI: 10.1056/NEJMicm2408573 A 50-year-old man presented with a 1-year history of progressive headaches and nausea. On physical examination, neck stiffness and dysmetria in both arms on finger-to-nose testing were noted. Results of a lumbar puncture revealed an opening pressure of 31 cm of water (reference range, 7 to 20), and cerebrospinal fluid studies we...

No ventilation, no ARDS: insights from four-dimensional computed tomography as dynamic imaging Okamura, G., Nishiyama, S., Ono, S. et al. Intensive Care Med (2024). https://doi.org/10.1007/s00134-024-07643-w A 63-year-old male, who was in remission from myelodysplastic syndrome after bone marrow transplantation, had previously undergone partial resection of the right upper lobe due to pulmonary aspergillosis. Over a year later, he presented with dyspnea and subse...

IMAGES IN CLINICAL MEDICINE Flail Chest Zhi Hu, Biao Wang N Engl J Med 2024;391: e22 A 59-year-old man with a history of chronic obstructive pulmonary disease was brought to the emergency department after a motor vehicle collision. The steering wheel of the patient’s car had struck his chest after the airbag had not deployed. His heart rate was 99 beats per minute, blood pressure 123/84 mm Hg, respiratory rate 30 breaths per minute, and oxygen saturation 9...