NEJM Image of the Week

• Coughing and Aerosols

  When a healthy volunteer coughs, he expels a turbulent jet of air with density changes that distort a projected schlieren light beam (Panel A). A velocity map early in the cough (Panel B) was . . .

• Pneumopericardium

  A 47-year-old homeless man presented to the emergency department 1 week after the onset of chest pain. He was hemodynamically stable. The physical examination was unremarkable. A routine complete blood count revealed 27,000 leukocytes per . . .

• New-Onset Clubbing Associated with Lung Cancer

  A 45-year-old woman with a 27-pack-year history of smoking presented for evaluation of progressive distal finger enlargement and polyarthralgias, which had developed over a period of 18 months. During the previous 3 months, she had . . .

• Colonic Saccular Diverticula

  A 61-year-old woman with severe pulmonary hypertension and an 8-year history of the CREST syndrome (calcinosis, Raynaud’s phenomenon, esophageal involvement, sclerodactyly, and telangiectasia) and with a positive anticentromere-antibody test was admitted to the intensive care . . .

• Strongyloides stercoralis Hyperinfection

  A 46-year-old man with Raynaud’s disease who emigrated from Cambodia 30 years ago presented with a 2-month history of myalgias, exertional dyspnea, and an elevated level of creatine kinase. An extensive evaluation was notable for . . .

• Austin Flint Murmur

  A 67-year-old woman presented with a 3-month history of progressive exertional dyspnea. Her blood pressure was 132/50, and her pulse was 74 beats per minute. Examination revealed a large-volume collapsing pulse, a short-ejection systolic murmur . . .

• Squamous-Cell Carcinoma Manifesting as a Cutaneous Horn

  A healthy 84-year-old woman presented with a 6-month history of a slowly growing asymptomatic lesion on the dorsum of her right hand. Physical examination revealed a keratotic cutaneous horn — approximately 6 to 7 cm . . .

• Gossypiboma in the Pouch of Douglas

  A 63-year-old woman presented with a 1-year history of vague pelvic and back pain. She had undergone laparoscopic surgery of the fallopian tubes 27 years earlier owing to infertility. Computed tomography of the abdomen showed . . .

• Imaging of Thebesian Venous System

  During left ventriculography in a 46-year-old man with hypertrophic cardiomyopathy, we injected 20 ml of contrast material, using a power injector at a rate of 10 ml per second through a multipurpose catheter (MPA2). . . .

• Allergic Bronchopulmonary Aspergillosis

  A 26-year-old man who smoked and had a long history of poorly controlled asthma and severe environmental allergies was admitted for an exacerbation of asthma. He reported no recent hospitalizations or exposure to tuberculosis and . . .