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) Patent Persistent Omphalomesenteric Duct

Pierre-Louis Verot et al, Published November 5, 2025, N Engl J Med 2025;393:1843 DOI: 10.1056/NEJMicm2509050, VOL. 393 NO. 18

Abstract

A 1-week-old full-term baby boy was brought to the hospital for evaluation of discharge from his navel. A growth of pink tissue at the umbilicus that seeped yellow liquid was noted.

(2). Images in Clinical Medicine: Goiter, Bounding Pulses, and Thyroid Bruit in Thyroid Storm

Takashi Yagi, Published November 1, 2025, N Engl J Med 2025;393: e31, DOI: 10.1056/NEJMicm2509136, VOL. 393 NO. 18

Abstract

A 20-year-old man with Graves’ disease presented to the ED with a 2-hour history of confusion. A goiter, bounding carotid pulses, and bruits over the thyroid (shown in videos) were noted on physical examination.

(3). Erythema Infectiosum

Jared Martinez-Coronado, etal, Published November 12, 2025, N Engl J Med 2025;393:1940, DOI: 10.1056/NEJMicm2509906,VOL. 393 NO. 19

Abstract

A previously healthy 8-year-old boy presented with a 7-day history of an itchy rash on both cheeks and a lacy rash on his chest and arms.

(4). Forehead Venous Pulsations in Severe Tricuspid Regurgitation

Elizabeth F. Aleong et al, Published November 8, 2025, N Engl J Med 2025;393: e33 DOI: 10.1056/NEJMicm2508078, VOL. 393 NO. 19

Abstract

An 89-year-old woman with severe tricuspid regurgitation presented with fever and cough after a recent diagnosis of influenza. Prominent forehead venous pulsations (shown in a video) were noted on examination.

(5). Ortner’s Syndrome in Pulmonary Hypertension

Rui Plácido, Published November 15, 2025.DOI: 10.1056/NEJMicm2510045

Abstract

A 26-year-old woman was referred to the pulmonary hypertension clinic with a 6-month history of exertional dyspnea and hoarseness. Vocal-fold paralysis was seen on laryngoscopy

Ortner’s syndrome, also known as cardiovocal syndrome, occurs when pulmonary hypertension causes the pulmonary artery to enlarge and compress the left recurrent laryngeal nerve, leading to hoarseness. This can also be caused by other enlarged cardiovascular structures, such as the left atrium, but severe pulmonary hypertension is a key cause where the nerve is compressed between the enlarged pulmonary artery and the aortic arch. Diagnosis involves evaluating symptoms like hoarseness alongside imaging to identify the enlarged cardiovascular structure and nerve compression.

Mechanism

  • Compression: The left recurrent laryngeal nerve runs through the chest under the aortic arch.
  • Enlargement: Pulmonary hypertension can cause the pulmonary artery to enlarge and stretch, applying pressure to the nerve.
  • Nerve damage: This pressure can damage the nerve, causing vocal cord paralysis or paresis, which results in hoarseness.

Causes

Severe pulmonary hypertension: This is a direct cause, often due to underlying heart or lung conditions like chronic obstructive pulmonary disease (COPD).

Enlarged left atrium: The historical cause, often seen with mitral stenosis, can also lead to this syndrome.

Other cardiovascular issues: Other causes can include atrial septal defects, patent ductus arteriosus, and aortic aneurysms.

Diagnosis

  • Clinical symptoms: Hoarseness is the primary symptom.
  • Imaging studies: Chest X-rays, computed tomography (CT) scans, and echocardiograms are used to visualize the heart, pulmonary artery, and aorta to identify the cause of nerve compression.
  • Laryngoscopy: This is used to directly examine the vocal cords and confirm vocal cord paralysis.

Treatment

Address the underlying cause: Treatment focuses on managing the pulmonary hypertension and its underlying cause to reduce the pressure on the nerve.

Symptomatic relief: Managing the hoarseness is secondary to treating the life-threatening cardiovascular disease.

(6). Cutaneous Metastases from Breast Carcinoma

Yu-Han Hsu et al, Published November 19, 2025, N Engl J Med 2025;393:2035DOI: 10.1056/NEJMicm2507508, VOL. 393 NO. 20

Abstract

A 75-year-old woman with a history of breast cancer treated with mastectomy of both breasts and adjuvant hormonal therapy presented with a 1-year history of a rash on her chest.

(7). Complete Heart Block Detected by Consumer-Facing Digital Health Technologies

James E. Published November 29, 2025, N Engl J Med 2025;393:2254, DOI: 10.1056/NEJMicm2510111, VOL. 393 NO. 22

Abstract

A 70-year-old man presented with several hours of shortness of breath and a slow heart rate that had been detected by the ballistocardiographic monitor in his commercial mattress.

(8). Empyema Necessitans

Adeoluwa Ayoola,  et al, published December 3, 2025,N Engl J Med 2025;393: e38,DOI: 10.1056/NEJMicm2504921,VOL. 393 NO. 22

Abstract

A 66-year-old man presented with 2 weeks of shortness of breath and cough, 5 days of left flank pain, and 2 days of a rapidly expanding mass on his left side.

(9). Aortic Intramural Hematoma

Sjoerd Bouwmeester et al, published December 6, 2025 ,DOI: 10.1056/NEJMicm2506150

Abstract

An 80-year-old man presented to the emergency department with a 12-hour history of pleuritic chest pain and an elevated d-dimer level. A CT scan showed an ulcerlike projection in the ascending thoracic aorta.

(10). Monteggia Fracture

Yen Cheng ChenPublished December 10, 2025, N Engl J Med 2025;393: e39, DOI: 10.1056/NEJMicm2510553, VOL. 393 NO. 23,

Abstract

A 26-year-old woman presented with left elbow pain after falling on an outstretched hand while ice-skating. Radiographs showed a fracture of the proximal third of the ulnar shaft and a posterior dislocation of the radial head.

(11). Cutaneous Sarcoidosis with Annular Plaques

Images in Clinical Medicine

Tianyi Zhang et al, Published December 13, 2025,DOI: 10.1056/NEJMicm2510745

Abstract

A 38-year-old woman presented with a 12-month history of annular plaques on the forehead, cheeks, and neck. Skin biopsy revealed non-caseating epithelioid granulomas with sparse lymphocytic infiltration in the superficial dermis

Nightingale Journals

Kauvery Hospital
Find Doctor
Book Appointment