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NEJM—Images in Clinical Medicine

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https://www.readbyqxmd.com/read/28636863/coronary-artery-vasospasm
#1
Takeshi Kondo, Kazuhiko Terada
A 52-year-old man who had a history of 34 pack-years of smoking presented to our primary care clinic with a 1-month history of episodic chest pain. The episodes occurred once every night while the patient was at rest, lasted for 15 minutes, and resolved without intervention. Sublingual..
June 22, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28636862/perirenal-extramedullary-hematopoiesis
#2
Ying-Nan Cheng, I-Wen Ting
A 69-year-old woman with chronic kidney disease and myelofibrosis presented to the emergency department with a 2-day history of dyspnea and general weakness. The patient had a hemoglobin level of 7.2 g per deciliter (reference range, 11.1 to 15.0), hyperkalemia, and a serum creatinine level of 6.7..
June 22, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28614692/seesaw-nystagmus
#3
K V S Hari Kumar, Pratima Singh
A 52-year-old man presented to the emergency department with a 1-year history of generalized headache, diminished vision, and abnormal eye movements. Examination of the fundus revealed disk pallor. His pupillary reflexes were normal, but there was reduced visual acuity (20/120) in both eyes and..
June 15, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28614685/strongyloides-stercoralis-hyperinfection
#4
Heidi H McDonald, Milton Moore
A 47-year-old man who had lived in Laos and was taking prednisone for dermatomyositis presented with a 4-day history of abdominal pain, fever, melena, and hemoptysis and a 2-week history of rash. One month before presentation, he had been hospitalized and treated with high-dose glucocorticoids for..
June 15, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28591532/mondor-s-disease
#5
Arun A Vijayalakshmi, Shrutiraaj Anand
A 53-year-old man with hypertension and diabetes mellitus presented with a 4-day history of dull, aching pain in his right nipple. He said that he had not had any fever, trauma, or discharge from the nipple. Physical examination revealed a tender subcutaneous cord that began below the right..
June 8, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28591531/large-arachnoid-cyst
#6
Jennifer de Longpre
A 27-year-old man presented to the emergency department after a first seizure. He reported that during the previous 3 years, he had had frequent headaches and falls. Magnetic resonance imaging of the brain revealed an arachnoid cyst, measuring 12.3 cm by 16.5 cm by 7.9 cm, with mass effect on the..
June 8, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28564574/evolution-of-purpura-fulminans
#7
Tamae Kugai, Hidenori Nakagawa
A previously healthy 3-year-old boy presented to a children’s hospital with fever and vomiting. On physical examination, he had small purpura on his legs (Panel A) that spread to his face, abdomen, and limbs during the ensuing 3 hours. Treatment with broad-spectrum antibiotic agents was initiated..
June 1, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28564573/dysphagia-after-occipitocervical-fusion
#8
Jaetaek Hong, Seonghoon Lim
A 64-year-old man presented with difficulty in swallowing immediately after he had undergone an operation to fuse the occiput to the cervical spine to correct atlantoaxial subluxation. Panel A shows a preoperative lateral plain radiograph, and Panel B, a postoperative radiograph. A..
June 1, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28538123/galloping-heart
#9
Binh An P Phan, Philip Chung
A 62-year-old man with a long-standing history of uncontrolled hypertension presented to the emergency department with chest pain. His blood pressure was 168/103 mm Hg. The left ventricular point of maximal impulse (PMI) was visible and prominent at the midclavicular line in the fifth intercostal..
May 25, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28538120/auer-rods
#10
Sarah W Gordon, Geoffrey W Krystal
A 69-year-old man was referred to our medical center for the evaluation and treatment of neutropenia and anemia. The complete blood count showed a white-cell count of 1000 per microliter (reference range, 4800 to 10,800 per microliter), with 10% neutrophils (absolute neutrophil count, 100) and a..
May 25, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28514617/scarlet-fever
#11
Alyson Brinker
A 20-year-old man presented to his primary care physician with a 3-day history of swollen tonsils, sore throat, fevers, chills, and rash. The nonpruritic rash had started on his abdomen, spread to his chest and back, and then appeared on his arms, legs, and face. He had no known allergies or..
May 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28514607/tuberous-sclerosis-complex
#12
Michele Marchini, Elisabetta Giglio
A 71-year-old man presented to the nephrology department for the evaluation of chronic kidney disease, which had developed during the past 20 years. The patient had received a diagnosis of tuberous sclerosis complex, or Bourneville’s disease, in his late 20s. The physical examination revealed..
May 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28490004/melanoma-of-the-foot
#13
Hui-Zi Gong, Jun Li
An 80-year-old man presented with a lesion on the left sole that had been increasing in size during the past 2 years. The lesion had become increasingly ulcerated, with intermittent bleeding. The physical examination revealed a well-defined, fleshy, reddish plaque measuring 2 cm in diameter with..
May 11, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28490003/binaural-tympanic-membrane-perforations-after-blast-injury
#14
Jeroen B van Rijswijk, Patrick Dubach
A 30-year-old man presented to the emergency department with new-onset hearing loss and tinnitus in both ears after a blast injury. While at a wedding that included celebratory fireworks, he had been standing near a sand-filled mortar when it accidentally ignited. Otoscopy revealed multiple..
May 11, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28467882/fluorescein-guidance-in-glioblastoma-resection
#15
David W Roberts, Jonathan Olson
A 55-year-old man presented to the emergency department with a 1-week history of severe headache. Magnetic resonance imaging of the brain with and without gadolinium-based contrast agent revealed a rim-enhancing mass (4.5 cm in diameter) in the right temporal lobe. At the time of surgery for tumor..
May 4, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28467872/traumatic-spondylolisthesis-of-the-axis
#16
Anis Khelifi, Faycel Saadaoui
A 25-year-old man presented to the emergency department with severe neck pain after he was involved in a high-speed collision between two vehicles. He had full strength in his arms and legs, normal sensation to light touch and pinprick, and no sphincter disorders. A lateral radiograph (Panel A)..
May 4, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28445673/extramammary-paget-s-disease
#17
Sarah H Mehrtens, Sriramulu Tharakaram
An 89-year-old man presented with a 1-year history of a nonhealing groin rash. The rash was not painful or pruritic. He had previously been treated empirically with oral and topical antibiotics, topical antifungal agents, and topical glucocorticoids without improvement. The physical examination..
April 27, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28445671/pyogenic-granuloma-of-the-conjunctiva
#18
Irene J Tan, Angus W Turner
A 30-year-old man presented with a pedunculated lesion on his right lower eyelid that had grown over a period of 3 days. Two weeks before presentation, a cyst had ruptured on the same eyelid. The new lesion started as a small lump on the bulbar conjunctiva and progressively increased in size until..
April 27, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28423304/candida-esophagitis
#19
Takeshi Kondo, Kazuhiko Terada
A 72-year-old man presented with a 2-week history of odynophagia (pain on swallowing). Sixteen months before the onset of this symptom, the patient had received a diagnosis of diffuse panbronchiolitis, and he had been receiving long-term treatment with macrolide antibiotics since then. He had not..
April 20, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28423297/osteopetrosis
#20
Udayshankar Yaga, Prashanth Panta
A 6-year-old girl was brought to the dentist by her parents, who reported that she had only a single tooth. Her medical history revealed that she was the child of consanguineous parents. She had partially impaired hearing and had lost her vision at 2 years of age. In addition, she had strabismus,..
April 20, 2017: New England Journal of Medicine
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