Toronto North York IMGs Study Group

A 42-year-old man presented to an emergency department in rural Colorado with a 2-day history of fever, cough with scant hemoptysis, chest pain, and myalgias. He reported no sick contacts and no oropharyngeal or gastrointestinal symptoms, rashes, or lymphadenopathy. The Now@NEJM blog has Clinical Pearls, Morning Report Questions, and free access to this latest Clinical Problem-Solving article. http://nej.md/1EXOsTb

A 46-year-old woman with end-stage liver disease complicated by recurrent hepatic hydrothorax requiring multiple thoracenteses presented with breathlessness. http://nej.md/1GPuzL9

Ebola virus was cultured from ocular fluid 14 weeks after onset of illness and 10 weeks after resolution of viremia. A new report demonstrates the potential for delayed clearance of virus from immunologically privileged sites. These results are being presented today at The Association for Research in Vision and Ophthalmology, and published on NEJM.org. http://nej.md/1zBPB2n

A previously healthy 65-year-old woman presented with a 7-day history of throat pain, difficulty swallowing, muffled voice, and fevers. http://nej.md/1CfbBMb

A 24-year-old man underwent thoracic surgery for pulmonary hydatid disease, and 8 weeks later, asymptomatic tumorlike, cutaneous lesions developed over the incision site. The patient was receiving albendazole as an adjunct therapy. http://nej.md/1ybz5WA

An 82-year-old man presented with episodic pain and a bulge along the right costal margin. He had undergone a minithoracotomy 4 years earlier for biopsy of recurrent squamous-cell carcinoma in the right lung. http://nej.md/1C8tGdE

A 62-year-old man presented with a 20-year history of frequent urination. CT of the abdomen and pelvis revealed a midline mass with central calcification superior to and compressing the bladder. Laparoscopy revealed a freefloating, smooth, firm, rubbery mass. http://nej.md/1DpjfcI

What is the most likely diagnosis in this 65-year-old woman with a 7-day history of throat pain and difficulty swallowing? Take the new Image Challenge now! http://nej.md/pPbCdb

Infection with which one of the following organisms is the most likely cause of this rash? Take the new Image Challenge now! http://nej.md/pPbCdb

A 31-year-old man was seen in the neurology clinic because of personality changes and neurologic decline of 3 years’ duration. Previous imaging studies showed mild atrophy in the frontal lobes. He could not speak or follow commands. Additional diagnostic testing was performed. The Now@NEJM blog has Clinical Pearls, Morning Report Questions and free access to this latest Case Record of the Massachusetts General Hospital. http://nej.md/1EqDSzY

In a randomized trial of 10,003 symptomatic patients with suspected coronary artery disease, clinical outcomes over 2 years were not improved with an initial strategy using coronary computed tomographic angiography compared with functional testing (exercise electrocardiogram, stress nuclear, or stress echocardiography). The results of the PROMISE study are being presented today at the American College of Cardiology meeting in San Diego, and published on NEJM.org. http://nej.md/1Aepp7F