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On the Cover


Rocky Perspective
by David L Shenson, MD

This photograph was taken at Ruby Beach, on the Olympic Peninsula in Washington. The contrast in depth of field creates an interesting perspective of these stones ground smooth by the elements and the passage of time. Dr Shenson is an Internist at the Mt Scott Medical Office in Clackamas, OR. More of his photography may be viewed at:

Soul of the Healer

TPJ 14 166A Pinnacle Etoc

Brad Christian McDowell, MD

TPJ 14 22A Seville Etoc

Samuel H Glassner, MD

TPJ 14 196A Dorothys View Etoc

Dorothy’s View
Bridget Bourgon, PA-C

TPJ 14 199A So Much Sky Etoc

So Much Sky
Colored pencils on paper
3” x 6”
Sharon Lee Hostler, MD

Online Only

Case Report


Pneumomediastinum Diagnosed on Ultrasound in the Emergency Department: A Case Report

An emergency ultrasound performed at bedside helped to confirm and to expedite the diagnosis of esophageal perforation in a 23-year-old man. To our knowledge, this is the first published report of using ultrasound as an aid in the diagnosis of Boerhaave syndrome by diagnosing pneumomediastinum in an adult male.


Case Report: Pulmonary Papillomatosis in a Patient Presenting with Cough and Hemoptysis

A previously healthy patient was seen in the Emergency Department for evaluation of a one-month history of cough and one-day history of hemoptysis. This case report, from a pulmonologist’s perspective, includes a comprehensive review of the patient’s clinical presentation and outcome, as well as a discussion of recurrent respiratory papillomatosis.

Clinical Medicine

Thrombosis Image Diagnosis: Inferior Mesenteric Vein Thrombosis

A 59-year-old man presented to the gastroenterology clinic with 2 weeks of worsening lower back pain. There was associated poor appetite, fatigue, night sweats, and chills. The patient’s medical history was significant for well-controlled hypertension and sigmoid diverticulosis. The thrombosis probably resulted from inflammation in the adjacent diverticulum.

Book Review

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

This book explores the ways that patients and healers can develop the skills to appropriately evaluate historic traumatic events and how to successfully begin treating them. From the scientifically oriented physician, the biochemical, physiologic, and anatomic effects of trauma on the body are well explored in this detailed exposé. What is more important though is the invisible mark that is embedded permanently on the mind and body by past traumatic events

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