Exenatide and Rare Adverse Events

n engl j med 358;18 www.nejm.org may 1, 2008 1969 Editor’s note: We received 1610 responses, from 85 countries, for this medical mystery. Sixty-two percent of respondents were physicians in practice, 21% were physicians in training, and 12% were medical students. Of the respondents, 65% identified some type of diaphragmatic hernia on the radiograph, which revealed a retrocardiac gastric shadow (Panel A). Specifically, 46% suggested a hiatal hernia, and 13% proposed another type of diaphragmatic defect such as Bochdalek’s or Morgagni’s hernia; 6% correctly identified gastric volvulus. The remaining 35% of respondents suggested a variety of diagnoses, including aortic aneurysm, Boerhaave’s syndrome, Zenker’s diverticulum, thymoma, pulmonary abscess, and achalasia.