NEJM - Image of the Week

Gouty Tophi

NEJM — 2009-11-18T17:00:00-05:00

A 77-year-old man presented with a 5-day history of painful swelling of his right elbow, which was also red, warm, and tender. When pressure was applied, a toothpastelike, white, chalky substance was easily expressible (Panel . . .

Geographic Tongue

NEJM — 2009-11-11T17:00:00-05:00

A 61-year-old man was referred for treatment of painless white lesions on his tongue that had appeared 1 month earlier. He had been treated with topical and systemic antifungal drugs for presumed oral candidiasis, but . . .

Injection-Site Lipoatrophy

NEJM — 2009-11-04T17:00:00-05:00

A 13-year-old girl with a 20-month history of type 1 diabetes mellitus presented with depressed areas of skin at the sites of insulin injection (Panel A, arrows). The patient had been treated since diagnosis with . . .

A Swinging Heart

NEJM — 2009-10-28T17:00:00-05:00

A 39-year-old woman with a 1-year history of Stage IV melanoma presented with progressive shortness of breath, fatigue, and edema in the legs, which had developed over the course of the previous week. At the . . .

Thoracic Kidney

NEJM — 2009-10-21T17:00:00-05:00

A 74-year-old man with diabetes and hypertension was referred to our hospital for evaluation of a mass in the right side of the chest, identified on a radiograph (Panel A, arrows). He reported no pulmonary . . .

Keratoconus Complicated by Acute Corneal Hydrops

NEJM — 2009-10-14T17:00:00-05:00

A 21-year-old woman with a history of myopia presented with the acute onset of foggy vision in her right eye and associated photophobia and mild sensation of the presence of a foreign body. Visual acuity . . .

Pachyderma

NEJM — 2009-10-07T17:00:00-05:00

A 65-year-old white man with a history of multiple myeloma presented with thick, leathery, gray skin of the torso and extremities. Panel A shows the left axilla. The patient reported intense pruritus and thickening of . . .

Cerebrospinal Fluid Leak

NEJM — 2009-09-30T17:00:00-05:00

A 50-year-old postmenopausal woman with asthma and allergic rhinitis presented with a 6-month history of unilateral rhinorrhea. When she woke in the mornings, she noticed a stain (halo) on her pillow. Rhinorrhea was precipitated by . . .

Diagnostic Finding in the Iris

NEJM — 2009-09-23T17:00:00-05:00

A 51-year-old woman was found to have a small, pinkish tumor of the left iris (Panels A and B, arrows). The visual acuity was not affected, and the intraocular pressure was normal. A tumor of . . .

Uvular Necrosis after Endoscopy

NEJM — 2009-09-16T17:00:00-05:00

A 28-year-old man presented with a sore throat 72 hours after undergoing upper endoscopy. The patient had a 6-month history of intermittent solid-food dysphagia; upper endoscopy revealed a Schatzki ring. A wire was placed endoscopically, . . .