Swirl Sign - Intestinal Volvulus after Roux-en-Y Gastric Bypass

Emphysematous Prostatitis - Radiography of the kidney, ureter, and bladder showed an atypical focus of gas accumulation behind the right pubic ramus (Panel A, arrows). Subsequent computed tomography (CT) of the abdomen revealed emphysematous prostatitis of the right prostate lobe (Panel B) #Clinical #Radiology #CT #KUB #EmphysematousProstatitis #Emphysematous #Prostatitis #NEJM

Emphysematous Pyelonephritis - Abdominal radiography (Panel A) and computed tomography (Panel B) revealed gas collection in the parenchyma (arrows) and perinephric space (arrowhead) of the left kidney. #Clinical #Radiology #EmphysematousPyelonephritis #Pyelonephritis #CT #KUB #NEJM

Calcified Spleen and Gallstones - An abdominal radiograph, which was obtained during a previous presentation for abdominal pain, showed a radiopaque gallstone (Panel A, arrowhead) and a calcified spleen (Panel A, arrow). A computed tomographic scan of the abdomen, obtained without the administration of contrast material, showed multiple gallstones and a calcified splenic pulp and capsule (Panel B). #Clinical #Radiology #KUB #CT #Calcified #Spleen #NEJM

Emphysematous Cystitis - A plain radiograph of the kidneys, ureters, and bladder showed air surrounding the bladder (Panel A, arrows). An abdominal computed tomographic scan revealed an area of gas dissecting the bladder wall, bilateral hydronephrosis, and intramural gas with a cobblestone or beaded-necklace appearance (Panel B, arrows) #Clinical #Radiology #EmphysematousCystitis #Cystiis #CT #KUB #NEJM

Decompression Sickness - The physical examination revealed diffuse violaceous skin mottling over his trunk and arms (Panel A). Given the extent of the nausea and vomiting as well as the elevated lactate level, abdominal computed tomography was performed, which showed air in the portal venous system (Panel B). #Clinical #Derm #EM #Radiology #DecompressionSickness #CutisMarmorata #PortalVenousGas #Pneumatosis #CT #NEJM

Falciform Ligament Sign - An abdominal radiograph that was obtained with the patient in a supine position revealed the falciform ligament sign (Panel A, arrow) — a radiographic sign of pneumoperitoneum. The falciform ligament connects the liver to the anterior abdominal wall. When surrounded by intraperitoneal free air, the falciform ligament may be seen as a vertical band of soft tissue on a computed tomographic scan of the abdomen (Panel B, arrow) #Clinical #Radiology #FalciformLigament #Pneumoperitoneum #CT #KUB #NEJM

Splenosis Mimicking Cancer - radiograph of the chest showed nodularity along the left hemidiaphragm (Panel A, arrows), raising the possibility of cancer. Computed tomography revealed several small, basilar, pleural nodules on the left side (Panel B, arrows) as well as a diaphragmatic defect and nodules in the splenic bed, with findings of prior splenectomy. #Clinical #Radiology #CXR #CT #Splenosis #Heterotopic #NEJM

Reversible Acute Mesenteric Ischemia - A computed tomographic scan showed jejunal dilatation and thinning of the bowel wall (Panel A, arrows), which suggested the recurrence of acute mesenteric ischemia in the remnant jejunum. Endoscopic examination through the jejunostomy revealed mucosal gangrene and hemorrhage (Panel B, Video 1). His symptoms abated within 14 days, at which time the patient underwent repeat endoscopy, which revealed mucosal healing #Clinical #Radiology #GI #MesentericIschemia #Mesenteric #Ischemia #EGD #CT #NEJM

Osteopetrosis - Computed tomography revealed diffusely thickened bones of the skull (Panel A, arrows). A radiograph of the wrists showed alternating sclerotic and lucent bands (Panel B, arrows). #Clinical #Peds #Radiology #Xray #HandXR #Osteopetrosis #CT #NEJM

Pemberton’s Sign in a Patient with a Goiter- Physical examination revealed an enlarged thyroid with no palpable nodules or cervical lymphadenopathy (Panel A). Pemberton’s sign — reversible facial congestion after elevation of both arms (Panel B and video) — was noted. The plasma thyrotropin level was 0.2 mIU per liter (reference range, 0.4 to 4.4), and the serum level of free thyroxine was normal. Computed tomography of the neck revealed an enlarged thyroid that was compressing the subclavian and jugular veins (Panel C) and a patent trachea that deviated to the left (Panel C, arrow). Pemberton’s sign is indicative of superior vena cava syndrome due to obstruction of the thoracic inlet. #clinical #photo #NEJM #Pembertons #sign #radiology #CT #goiter