Image Challenge — June 4, 2026 @NEJMgroup

Uploaded June 2026 | Updated September 2026, 1 week ago

An 11-year-old girl presented to the orthopedic clinic with a 1-month history of right thigh pain that worsened at night. Physical examination was notable for soft-tissue swelling over the distal thigh and limited range of motion of the knee on the right side. What is the most likely diagnosis?

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$HFpEF Explained — Prevalence, New Advances, and How to Diagnose | NEJM This first episode of a three-part Double Take video miniseries on heart failure with preserved ejection fraction (HFpEF) from the New England Journal of Medicine discusses how HFpEF differs from heart failure with reduced ejection fraction, key risk factors, underlying causes, and the challenges of diagnosis. The cardiologists walk through the diagnostic evaluation, including use of the H2FPEF score to support clinical decision making. For further reading, the following articles, referenced in this video, are available at NEJM.org: Empagliflozin in Heart Failure with a Preserved Ejection Fraction (Anker et al., in the October 14, 2021, issue, https://www.nejm.org/doi/full/10.1056/NEJMoa2107038 ), Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity (Kosiborod et al., in the September 21, 2023, issue, https://www.nejm.org/doi/full/10.1056/NEJMoa2306963 ), Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (Solomon et al., in the October 24, 2024, issue, https://www.nejm.org/doi/10.1056/NEJMoa2407107 ), Heart Failure with Preserved Ejection Fraction (Cannata and McDonagh, in the January 9, 2025, issue, https://www.nejm.org/doi/full/10.1056/NEJMcp2305181 ), and Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity (Packer et al., in the January 30, 2025, issue, https://www.nejm.org/doi/full/10.1056/NEJMoa2410027 ). Funding for this Double Take is provided by the Doris Duke Foundation, committed to building a creative, equitable, and sustainable future. #medicaleducation #clinicalmedicine #nejm The New England Journal of Medicine is the world’s leading general medical journal. Continuously published for over 200 years, the Journal publishes peer-reviewed research along with interactive clinical content for physicians, educators, and the global medical community at NEJM.org.$

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Image Challenge — June 4, 2026