Journal scan: A review of images in clinical medicine of immediate clinical significance, harvested from major international journals

From the desk of the Editor-in-chief

Images in Clinical Medicine

(1). Frostbite Injury from Inhaled Nitrous Oxide Use

Michael Patrizio, Published July 2, 2025, N Engl J Med 2025;393: e1,DOI: 10.1056/NEJMicm2502232,VOL. 393 NO. 1

Abstract

A 23-year-old man presented with a 2-day history of painful swallowing and hoarseness. The symptoms had started immediately after he had inhaled nitrous oxide through his mouth from a hand-held canister for recreation.

(2). Whipple’s Disease with Endocarditis

Paula Ackermann, Published July 5, 2025,DOI: 10.1056/NEJMicm2413719

Abstract

A 51-year-old man presented with a 3-month history of weight loss, diarrhea, and fever. Transthoracic echocardiography showed vegetations on the aortic and mitral valves. A duodenal biopsy showed periodic acid–Schiff–positive macrophages.

(3). Practical Prescribing: Aspirin

Marc George et al, BMJ 2025; 390 doi: https://doi.org/10.1136/bmj-2024-081606 (Published 02 July 2025, BMJ 2025;390:e081606

What you need to know

Aspirin has multiple indications, including prevention of coronary, cerebrovascular, and peripheral vascular disease; treatment of acute coronary syndromes and ischaemic stroke; prevention of pre-eclampsia; and colorectal cancer in Lynch syndrome, as well as pain, migraine, and pyrexia.

Consider starting aspirin for a clinical diagnosis of stable angina while awaiting a formal cardiology assessment.

Before prescribing aspirin, screen for gastrointestinal symptoms, assess risk of gastrointestinal bleeding, and consider co-prescribing a proton pump inhibitor.

Enteric coated aspirin does not reduce the risk of gastrointestinal side effects and is therefore not recommended.

(4). Incarcerated Femoral Hernia

Pratyaksha Rana et al, Published July 9, 2025,N Engl J Med 2025;393: e2,DOI: 10.1056/NEJMicm2500535,VOL. 393 NO. 2

Abstract

A 77-year-old woman presented with a 2-day history of abdominal pain, nausea, and vomiting. CT of the abdomen revealed herniation of a loop of ileum that was inferior to the inguinal ligament and lateral to the pubic tubercle.

(5). Microcysts in Lithium-Induced Nephropathy

Cheng-Hung Liao, Published July 12, 2025;N Engl J Med 2025;393: e3

DOI: 10.1056/NEJMicm2500259,VOL. 393 NO. 3

Abstract

A 60-year-old man with hypertension and bipolar disorder was incidentally found to have small cysts on his kidneys during MRI of the abdomen.

(6). Löfgren’s Syndrome

Maged Hassan, Published July 23, 2025,N Engl J Med 2025;393:389,,DOI: 10.1056/NEJMicm2501706,VOL. 393 NO. 4

Abstract

A 26-year-old man who had emigrated from Nepal 7 years earlier presented with ankle swelling, cough, unintentional weight loss, and a leg rash. A chest radiograph showed hilar lymphadenopathy.

(7). Spontaneous Intracranial Hypotension

Syeda Busmah Owais et al, Published July 30, 2025, N Engl J Med 2025;393:487,DOI: 10.1056/NEJMicm2502293,VOL. 393 NO. 5

Abstract

A 50-year-old woman presented with a 10-day history of headache that worsened when she was upright and abated when she lay flat. An MRI of the brain showed diffuse pachymeningeal enhancement and tonsillar ectopia.

(8). Acrometastases

Harriet O’Rourke, Published July 16, 2025,N Engl J Med 2025;393:289. DOI: 10.1056/NEJMicm2501158,VOL. 393 NO. 3

Abstract

A 55-year-old man with metastatic squamous-cell lung cancer presented with a 6-week history of pain and swelling of the right great toe and the tip of the right middle finger.

(9). Hydroxychloroquine Retinal Toxicity

Aaron Donnelly etal, Published July 19, 2025,DOI: 10.1056/NEJMicm2500141

Abstract

A 71-year-old woman with systemic lupus erythematosus presented to the ophthalmology clinic for an annual screening examination for hydroxychloroquine-related toxic effects. She reported no vision changes.

(10). Spontaneous Intracranial Hypotension

Published July 30, 2025,N Engl J Med 2025;393:487,DOI: 10.1056/NEJMicm2502293,VOL. 393 NO. 5

Abstract

A 50-year-old woman presented with a 10-day history of headache that worsened when she was upright and abated when she lay flat. An MRI of the brain showed diffuse pachymeningeal enhancement and tonsillar ectopia.

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