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) 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.

(2). Whipple’s Disease with Endocarditis

Paula Ackermann et al, Published July 5, 2025,N Engl J Med 2025;393:175,DOI: 10.1056/NEJMicm2413719,VOL. 393 NO. 2

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) E-Cigarette– or Vaping-Associated Lung Injury

Mohd Zulkimi Roslly et al, Published August 2, 2025,N Engl J Med 2025;393:592.

A 27-year-old man with a long history of asthma presented to the emergency department with a 5-day history of fever, vomiting, diarrhea, dyspnea, and hemoptysis. One year before presentation, he had switched from smoking tobacco cigarettes to vaping. He also worked at an e-cigarette store, where he was exposed to second-hand e-cigarette vapors. The respiratory rate was 44 breaths per minute, and the oxygen saturation 83% while the patient was breathing ambient air. On physical examination, crackles were noted in both lungs. Endotracheal intubation was performed. A chest radiograph showed patchy consolidations on both sides (Panel A). Computed tomography of the chest revealed consolidations and ground-glass opacities in both lungs, with sparing of the subpleural areas (Panel B), as well as pleural effusions on both sides, with a greater amount of fluid on the right than on the left (Panel C). Testing of serum and bronchoalveolar lavage (BAL) fluid was negative for infectious diseases and rheumatologic conditions. BAL fluid testing for vitamin E acetate and tetrahydrocannabinol — two substances in vaping oils that are associated with lung injury — was not available. A diagnosis of e-cigarette– or vaping-associated lung injury was made. Treatment with a 4-week tapering course of systemic glucocorticoids was initiated. The patient was extubated after 1 month, and he was discharged with no need for oxygen supplementation.

(4). Snowman Sign in Pituitary Macroadenoma

Yuwei Zhou et al, Published August 13, 2025. N Engl J Med 2025;393:699.

Abstract

A 47-year-old woman presented with a 1-month history of headaches and blurry vision. An MRI of the head showed an enlarged pituitary gland protruding from the sella turcica, known as the “snowman sign.”

(5). Paraganglioma in the Organ of Zuckerkandl

Ricky Cohen et al, Published August 16, 2025,N Engl J Med 2025;393:798.

Abstract

A 39-year-old man presented with a 1-day history of lower abdominal pain. The blood pressure was 203/132 mm Hg. Imaging revealed a retroperitoneal mass inferior to the aortic bifurcation.

(6). Abdominojugular Reflux Test

Stephen Bent et al, Published August 20, 2025,N Engl J Med 2025;393: e10.

Abstract

A man with heart failure presented with 2 weeks of shortness of breath. The jugular venous pressure was seen at the angle of the jaw and increased for more than 10 seconds when pressure was applied to the abdomen.

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