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Prominent superficial veins over the right upper arm and shoulder, reflective of Urschel's sign.

Urschel’s Sign in Paget Schroetter Syndrome

A 32-year-old man, employed as a deckhand, was referred for right upper extremity swelling and pain of 3 months’ duration. Physical examination revealed swelling of the right upper extremity and prominent superficial veins over the right upper arm and shoulder (Urschel’s sign; Figure). Blood work including thrombophilia screen was unremarkable. Right upper extremity venous duplex ultrasonography […]

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Pertinent findings at autopsy included (A) the heart showing multiple foci of subepicardial acute infarction (gross image) and (B) platelet fibrin thrombi in the coronary microvasculature (hematoxylin & eosin stain, 400×).

An Unusual Presentation of Thrombotic Thrombocytopenic Purpura

  We describe a patient with sudden and severe postoperative thrombocytopenia whose diagnosis was delayed. The patient was a 58-year-old black man with diabetes mellitus type 2, hypertension, and chronic kidney disease, who presented to our institution with 4 days of abdominal pain. He had a history of remote exploratory laparotomy for an abdominal gunshot […]

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Figure 1
(A) Superficial veins were apparent on the patient's chest (red arrows). (B) Computed tomography revealed a mediastinal mass (blue arrows), as well as multiple venous collaterals (red arrowheads). (C) The mass protruded through the superior vena cava and entered the right atrium (green arrow). (D) 18F-fluorodeoxyglucose positron emission tomography showed that the mass, including the portion extending into the vena cava, was hypermetabolic (purple arrow, maximum standardized uptake value = 10).

The Hypermetabolic Mushroom

The Hypermetabolic Mushroom: Superior Vena Cava Syndrome   Presentation A 40-year-old man, who had had a successful heart transplant, later developed a very rare and unrelated cardiac problem. He presented with progressive symptoms of cough along with cyanosis and swelling of the face and arms. On examination, he had edema of the face and upper […]

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American Journal of Medicine Editor Joseph Alpert

The Risk of Stent Thrombosis after Coronary Arterial Stent Implantation

One of the most dreaded complications after percutaneous coronary arterial angioplasty is stent thrombosis. This serious untoward event usually results in acute myocardial infarction with high mortality. Stent thrombosis often occurs early, within 30 days of implantation, in patients who receive bare metal coronary arterial stents. However, patients undergoing drug-eluting stent implantation infrequently develop late […]

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