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EDUCATION EXHIBIT 129

Eponyms in Radiologyof the Digestive Tract:Historical Perspectivesand Imaging Appear-ancesPart I. Pharynx, Esophagus, Stomach,and Intestine1

Jeffrey P. Kanne, MD ● Charles A. Rohrmann, Jr, MD ● Joel E.Lichtenstein, MD

Eponyms serve as a means of honoring individuals who have made im-portant discoveries and observations. Eponyms are frequently encoun-tered in the field of radiology, particularly in radiology of the digestivetract. However, the use of eponyms may fail to convey a precise mean-ing or definition and could lead to miscommunication. Moreover, insome instances, more than one individual may have contributed to thediscovery or description of a particular anatomic structure or disease,whereas in others, an eponym may have been incorrectly applied ini-tially and propagated for years in the medical literature. Nevertheless,radiologic eponyms are a means of honoring those who have made last-ing contributions to the field of radiology, and familiarity with theseeponyms is important for proper reporting and accurate communica-tion. In addition, the acquisition of some historical knowledge aboutthose whose names are associated with various structures or pathologicconditions brings some humanity back into the science of medicine.©RSNA, 2006

RadioGraphics 2006; 26:129–142 ● Published online 10.1148/rg.261055084 ● Content Code:

1From the Department of Radiology, University of Washington, Box 357115, 1959 NE Pacific, Seattle, WA 98195-7115. Presented as an educationexhibit at the 2004 RSNA Annual Meeting. Received April 8, 2005; revision requested May 4 and received June 15; accepted June 17. All authors haveno financial relationships to disclose. Address correspondence to C.A.R. (e-mail: [email protected]).

©RSNA, 2006

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IntroductionIn the context of medicine, an eponym is definedas “a name of a drug, structure, or disease basedon or derived from the name of a person” (1).Eponyms are frequently encountered in radiol-ogy, particularly that of the digestive tract, andknowledge of these terms is important for properreporting and communication. Eponyms are ameans of honoring individuals who have madecontributions to medicine, but use of these termsmay fail to convey a precise meaning or definitionand could lead to miscommunication. Further-more, it may be that more than one individualcontributed to the discovery or description of astructure or disease. In other cases, an eponymmay have been incorrectly applied initially andpropagated for years in the medical literature.

In this article, the first of a two-part series, wediscuss and illustrate the imaging manifestationsof eponyms encountered in radiology of the phar-ynx (Zenker diverticulum), esophagus (Mallory-Weiss tear, Boerhaave syndrome, Schatzki ring,Barrett esophagus), stomach (Zollinger-Ellisonsyndrome, Menetrier disease, Carman meniscussign), small bowel (Meckel diverticulum), andcolon (Hirschsprung disease, crypts of Lieber-kuhn, Escherichia coli colitis). We also explore thehistorical background of the individuals for whomthese eponyms were named.

Pharynx

Zenker DiverticulumZenker diverticulum (Fig 1) is a pulsion pseudo-diverticulum that occurs posteriorly in the mid-line just proximal to the cricopharyngeus (2). Itresults from herniation of mucosa and submu-cosa through the dehiscence of Killian, a focal

Figures 1, 2.(1) Zenker diverticu-lum. Lateral single-contrast esophago-gram shows a largeoutpouching (*) aris-ing from the regionof the cricopharyn-geus posterior to thenormal esophagus(arrow). (2) Fried-rich Albert von Zen-ker (1825–1898).(From the NationalLibrary of Medicine,Washington, D.C.)

130 January-February 2006 RG f Volume 26 ● Number 1

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weakness in the hypopharynx at the normal cleav-age plane between the fibers of the inferior pha-ryngeal constrictor and the cricopharyngeus. Thisphenomenon may lead to the creation of a sacwith a narrow neck that can trap food and liquid,leading to dysphagia, halitosis, and regurgitation.

Friedrich Albert von Zenker (1825–1898) (Fig2) was born in Dresden, Germany (the distin-guished “von” in his name was added later whenhe was admitted to the German nobility in recog-nition of his accomplishments). He studied medi-cine at Leipzig and Heidelberg and then becamethe assistant to Professor Karl Freiherr von Roki-tansky in Vienna. Von Zenker then became Pro-fessor of Pathology at Erlangen University andserved as dean of the medical faculty and prosec-tor there. His monograph entitled Krankenheitendes Oesophagus was published in 1867 in collabo-ration with his clinical colleague Hugo Wilhelmvon Ziemmsen, citing all previous reports of hy-popharyngeal pulsion diverticula. Von Zenkerwas also known by his contemporaries for his dis-covery of the pathogenesis of trichinosis and hisextensive work on pneumoconiosis (3).

Esophagus

Mallory-Weiss TearMallory-Weiss tear (Fig 3) is a partial-thicknesstear of the esophagus that involves only the mu-cosa and often extends into the gastric cardia (4).It occurs in the distal esophagus and is usually theresult of violent retching. Mallory-Weiss tear isdifficult to diagnose with esophagography, butwhen identified, it manifests as a 1–4-cm longitu-dinal collection of barium in the distal esophagus.

George Kenneth Mallory (1900–1986) (Fig 4)was born in Boston and received his medical de-gree from Harvard Medical School in 1926. Likehis father, Frank Burr Mallory (1862–1941), forwhom Mallory bodies are named, George Mal-lory was also a pathologist (5). He became Profes-sor of Pathology at Boston University and workedfor an extended period at the Mallory Institute ofPathology, the institution founded by his father.His primary interest was in disease of the kidneysand liver (6).

Figures 3, 4.(3) Mallory-Weisstear. Air-contrastesophagogram showslongitudinal tears atthe esophagogastricjunction. (4) GeorgeKenneth Mallory(1900–1986). (Fromthe National Libraryof Medicine.)

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Soma Weiss (1898–1942) (Fig 5) was born inBestereze, Hungary, and emigrated to the UnitedStates in 1920 during the chaos that engulfed Eu-rope following World War I. He received hismedical degree from Cornell Medical College in1923 and eventually became Physician-in-Chiefat Peter Bent Brigham Hospital in Boston (5).

Weiss’s most significant contribution to medi-cine was his work in cardiovascular disease, par-ticularly his focus on unusual causes and manifes-tations of heart failure and the importance of thenervous system in cardiovascular physiology. Hehad a reputation for being an outstanding bedsideteacher and diagnostician, and word of his fa-mous Tuesday night rounds at Boston City Hos-pital quickly spread throughout the United Statesand the world (7). Weiss died in 1942 from a rup-tured cerebral aneurysm that he himself diag-nosed on his deathbed (5).

Boerhaave SyndromeBoerhaave syndrome describes rupture of theesophagus resulting from violent emesis (8). Thetear almost always occurs in the left posterior wallnear the left diaphragmatic crus, and esophagealcontents can spill into the left pleural space ordissect between the parietal pleura and the leftcrus. Chest radiographic findings include pneu-momediastinum, abnormal mediastinal contours,and hydropneumothorax.

Hermann Boerhaave (1668–1738) (Fig 6) wasborn in Voorhout, the Netherlands. His father, apreacher, educated him at home, teaching himGreek, Latin, and other languages, and encour-aged his son to follow in his path. Boerhaave’sfuture in the clergy came to an abrupt halt whenhe was traveling by boat with a group of passen-gers who were discussing the doctrines of Spi-noza, a man accused of heresy. Boerhaave askedone particular denouncer if he had actually readSpinoza, effectively silencing the critic. However,he was quickly labeled as one who shared Spino-za’s atheistic views.

Fortunately for Boerhaave, he had alreadybeen drawn to mathematics and the sciences dur-ing his studies in theology, and the logical choicefor him was to turn to medicine. His great intel-lect allowed him to learn everything on his own,attending only dissections. He rose through theranks at Leiden University, becoming Professor ofClinical Medicine, Botany, and Chemistry, andultimately serving as president of the university.

Boerhaave syndrome was so named on thestrength of Boerhaave’s detailed description ofthe ruptured esophagus of the ill-fated Baron Jo-hannes von Wassenaar, the Grand Admiral of theDutch fleet, who had the reputation of being arather sedentary gourmand. Reportedly, theBaron dined on a rather large meal and, severalhours later, because of dyspepsia, took severaldoses of an emetic. Subsequent retching caused atearing chest pain, which the Baron described as

Figure 5. Soma Weiss (1898–1942). (Fromthe National Library of Medicine.) Figure 6. Hermann Boerhaave (1668–1738).

(Old engraving from Leiden, the Netherlands.)


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“something having broken or torn.” Despite un-dergoing extensive treatment by Boerhaave, theBaron died within 24 hours.

Upon opening the Baron’s chest at autopsy,Boerhaave discovered subcutaneous emphysema,a large volume of intraabdominal air, and the ran-cid odor of the Baron’s last meal. Both lungs werecollapsed, and the pleural spaces were filled withlarge volumes of liquid. A finger-sized tear wasidentified on the left side of the esophagus, andBoerhaave concluded that the tear was the resultof the violent retching resulting from the Baron’singestion of the emetic. Boerhaave published adetailed account of this disease, deeming it to beentirely incurable (9).

However, Boerhaave’s greatest contributionsto medicine were as a clinician and teacher. Lei-den had become the most outstanding medicalschool in Europe, attracting young men from allover the Continent. Boerhaave advocated bedsideteaching, setting aside 12 dedicated clinical teach-ing beds at St Caecilia Gasthuis, to which hebrought his students for daily teaching exercises.His method of clinical evaluation is not unlike ourmodern medical history and physical examina-tion.

Boerhaave suffered from severe gout and, de-spite his medical expertise, was unable to success-fully treat the debilitating pain or shorten thecourse of the disease. He died in 1738 from com-plications of a lung abscess. However, he died a

wealthy man, reportedly leaving millions of guil-ders to his daughters (10).

Schatzki RingA Schatzki ring (Fig 7) is a symptomatic mucosalfold found at the squamocolumnar junction in thedistal esophagus (11). The primary symptoms aredysphagia or pain associated with food impactionand generally develop when the diameter of thering narrows to 11 mm (12).

Richard Schatzki (1901–1992) (Fig 8) wasborn in Clafeld, Germany, and received his medi-cal training at the University of Berlin. He studiedradiology under Hans Heinrich Berg (1889–1968), the leading diagnostic radiologist in Ger-many at that time, since he could not decide be-tween a career in surgery or internal medicine. Hewas appointed Chief of the Radiology Depart-ment at the University Hospital in Leipzig in1929 and studied radiology of esophageal andgastric varices. In 1933, Schatzki spent some timeat Massachusetts General Hospital as an assis-tant in the radiology department. FollowingWorld War II, he was named Chief of the Radiol-ogy Department at Mount Auburn Hospital inCambridge, Massachusetts. Schatzki held theposition of Associate Clinical Professor of Radiol-ogy at Harvard Medical School and served as

Figures 7, 8.(7) Schatzki ring.Air-contrast esopha-gogram shows con-centric narrowingjust above the esoph-agogastric junction.(8) Richard Schatzki(1901–1992). (Cour-tesy of Stefan Schat-zki, MD, Depart-ment of Radiology,Mount Auburn Hos-pital, Cambridge,Mass.)


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President of the New England Roentgen Ray So-ciety. In addition to being a radiologist, Schatzkiwas an accomplished pianist and gave variousbenefit concerts in the Boston area (6).

Barrett EsophagusBarrett esophagus (Fig 9) is defined as intestinalmetaplasia of the esophageal mucosa, thought toarise from chronic reflux esophagitis. Tradition-ally, Barrett esophagus has been considered to bea risk factor for developing esophageal adenocar-cinoma. However, recent years have seen a grow-ing debate among gastroenterologists and pa-thologists as to the true cause and significance ofthe metaplasia (13).

Imaging findings that suggest Barrett esopha-gus include a benign-appearing esophageal stric-ture, particularly when the stricture occurs in themore proximal esophagus. Small, plaque-like mu-cosal irregularities may also be identified near astricture at high-quality double-contrast esopha-gography (14).

Norman Rupert Barrett (1903–1979) (Fig 10),nicknamed “Pasty,” was a British surgeon born inAdelaide, Australia. He emigrated to England at10 years of age and received his undergraduateeducation at Cambridge University. He served aseditor of Thorax from 1946 to 1971 and as presi-dent of several surgical societies. Barrett spentmost of his career at St Thomas Hospital, wherehe established one of the first thoracic surgery andintensive care units (6).

In 1950, Barrett published a report in which hedefined the esophagus as “that part of the foregut,distal to the cricopharyngeal sphincter, which islined by squamous epithelium” (15). Ironically,an esophagus lined extensively by columnar epi-thelium is referred to as Barrett esophagus. How-ever, Barrett was not the first to describe this co-lumnar epithelial lining of the esophagus. In his1950 treatise, Barrett supported the view that theulcerated, columnar epithelium–lined organ was atubular segment of stomach that was tethered inthe chest by a congenitally short esophagus. In1953, Allison and Johnstone argued that this co-lumnar epithelium–lined structure was indeed theesophagus and suggested that the ulcerations inthis structure be called “Barrett’s ulcers.” Notuntil 7 years after his initial treatise did Barrettaccept that this columnar epithelium–lined struc-ture was the esophagus, suggesting that it becalled the “lower esophagus lined by columnarepithelium.” Despite earlier reports, Barrett failedto mention that intestinal-type epithelium couldbe present (16).

Stomach

Zollinger-Ellison SyndromeZollinger-Ellison syndrome (Fig 11) (17) iscaused by a gastrin-secreting islet cell neoplasm(gastrinoma) that stimulates acid hypersecretionby parietal cells in the gastric fundus and upperbody. These two sites subsequently becomegrossly hyperplastic, a phenomenon that accountsfor much of the fold thickening, to which inflam-mation adds more distally. Approximately 60% of

Figures 9, 10. (9) Barrettesophagus with adenocarci-noma. Single-contrast esopha-gogram shows multiple irregu-lar filling defects in the loweresophagus. (10) Norman Ru-pert Barrett (1903–1979).(From the National Libraryof Medicine.)


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gastrinomas are malignant, and these malignantneoplasms can be associated with multiple endo-crine neoplasia syndrome type I. Gastrinomasmost commonly occur in the pancreas, with theduodenum and other sites being less commonlyaffected. The continuous secretion of gastrinleads to increased gastric acid production, result-ing in severe peptic ulcer disease. Characteristicradiographic findings include multiple gastric andduodenal ulcers, with distal duodenal ulcers beinghighly suggestive of the disease, as well as gastricand duodenal fold thickening. Hypersecretion canalso lead to barium dilution with poor coating.

Robert Milton Zollinger (1903–1992) (Fig 12)was an American surgeon born on a farm in Mil-

lersport, Ohio. He joined the army in 1941 andbecome Assistant Chief of the Surgical Service forhis unit. Zollinger served as Chairman of the De-partment of Surgery at Ohio State Universityfrom 1947 to 1974 and as Editor-in-Chief of theAmerican Journal of Surgery from 1958 to 1986.He had a reputation for using “vigorous” andrather unconventional teaching methods. Hisgentler side was characterized by his skills as achampion grower of gourds and his role as a na-tional rose judge (18,19).

Edwin H. Ellison (1918–1970) (Fig 13) wasan American surgeon born in Dayton, Ohio, who

Figures 11–13. (11) Zol-linger-Ellison syndrome. Im-age from a single-contrast up-per gastrointestinal studyshows thickened and irregulargastric folds, hypersecretion,and smooth thickening of thesmall bowel folds. A gastri-noma was found at surgery.(12) Robert Milton Zollinger(1903–1992). (13) Edwin H.Ellison (1918–1970). (Cour-tesy of E. Christopher Ellison,MD, Department of Surgery,Ohio State University, Colum-bus, Ohio.)


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served as Chairman of the Department of Surgeryat Marquette University. He was a prolific writerand a member of the editorial board of numerousjournals. In 1955, he and Zollinger described thesyndrome that now bears their names.

Menetrier DiseaseMenetrier disease (Fig 14), also referred to as gi-ant hypertrophic gastropathy, is a rare diseasecharacterized by marked gastric mucosal foldthickening, hypersecretion, hypochlorhydria, andhypoproteinemia (20). Rugal thickening occursprimarily in the gastric fundus and body, oftenwith antral sparing (21). At palpation, the foldsremain pliable.

Pierre-Eugene Menetrier (1859–1935) (Fig15) was born in Paris. Although his father, a liter-ary critic, inspired in his son a lifelong interest inhistory and literature, Menetrier opted to pursuea career in medicine, enrolling at the medicalschool of the University of Paris. He became apathologist, was promptly promoted to professor,and was recognized as a talented investigator. Hewas among the first to recognize the transforma-tion from benign to malignant neoplasia, implied

in his description of the exuberant gastric muco-sal hyperplasia now bearing his name. AlthoughMenetrier recognized the debility of patients af-flicted with this disease, the associated protein-losing gastroenteropathy was not recognized untillater. His other works include writings on Byzan-tine and Greco-Roman medicine. Menetrier diedfrom injuries sustained in an automobile accidentin Limieux, France, in 1935 (22).

Carman Meniscus SignThe Carman meniscus sign (Fig 16) is created bya large, flat ulcer with heaped-up edges. Theedges of the ulcer trap a lenticular barium collec-tion that is convex relative to the lumen when theedges are folded upon themselves during com-pression. These findings are indicative of a malig-nant gastric ulcer (23).

Russell Daniel Carman (1875–1926) (Fig 17)was born in Iroquois, Ontario, Canada, and, as ateenager, emigrated first to Butte, Montana, andlater to St Paul, Minnesota, with his mother. Hestudied medicine, first at the University of Min-nesota and then at Marion Sims College of Medi-cine in St Louis, from where he received his MDdegree in 1901. He studied under William Oslerat Johns Hopkins Medical School from 1901 to

Figures 14, 15. (14) Menetrier disease. Image from an upper gastrointestinal study shows marked thickening(arrows) of the fundal gastric folds. (15) Pierre-Eugene Menetrier (1859–1935). (From the National Library ofMedicine.)


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1902 and then returned to St Louis, where heworked as a general practitioner.

Carman acquired an x-ray machine early in hiscareer and, through detailed observation and dili-gent work, became a recognized expert in x-raydiagnosis in the St Louis area. Prior to beingnamed head of the Mayo Section on Roentgen-ology in 1913, he was appointed Professor ofRoentgenology at the medical schools of St LouisUniversity and Washington University.

Carman’s work pioneered gastrointestinal radi-ology, resulting in the publication of The RoentgenDiagnosis of Diseases of the Alimentary Canal in1917. He made frequent trips to the operatingroom to confirm his radiologic findings. In im-proving roentgenographic evaluation of the diges-tive tract, Carman advocated rapid screeningfluoroscopy with manual palpation in an era ofunreliable spot radiographs. To increase examina-tion throughput, he emphasized making brief re-ports that omitted normal findings, as well as di-rect dictation into a tape recorder. He advocatedmeticulous recordkeeping and collection of cases,stating that “progress in roentgen diagnosis liesalong three definite lines: ample material, full re-

cording of all interpretations of this material, andcareful comparison of those interpretations withsurgical and pathologic findings.”

Carman became concerned about early abuseof the x-ray and advocated that roentgenologybecome a separate medical specialty. In 1910, hewrote, “Successful employment of the x-ray de-mands an intimate knowledge of a highly complexapparatus, practical acquaintance with the essen-tials of a good radiogram, ability to interpret aradiograph properly . . . and an appreciation ofthe dangers which may attend their careless andunskilled application.” In 1915, Carman becameone of the 30 charter members of the RadiologicalSociety of North America, serving as president in1923. He was subsequently elected President ofthe American Roentgen Ray Society in 1924, theonly person to serve as president of both organiza-tions.

Carman became ill in the fall of 1925 whilereturning to Rochester, Minnesota, from Wash-ington, D.C., by train. His colleagues performeda fluoroscopic examination of his stomach and,

Figures 16, 17. (16) Carman meniscus sign and gastric adenocarcinoma. Image from a single-contrast upper gas-trointestinal study shows a large filling defect (arrows) in the antrum with a large central ulcer (*) convex relative tothe lumen. (17) Russell Daniel Carman (1875–1926).


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upon seeing the images, left them on his deskwithout comment. Carman held the films up tothe window and stated, “Cancer of the stomach,inoperable.” Within the hour, he drove to St Pauland lectured before 2,600 physicians at the Inter-state Postgraduate Assembly of North America.Carman remained active in roentgenology untilhis death in 1926. He bequeathed funds for aCarman Scholarship in Roentgenology and do-nated his medical library to the Department ofRadiology at the Mayo Clinic (24).

Meckel DiverticulumMeckel diverticulum (Fig 18) is the remnant ofthe omphalomesenteric (vitelline) duct and is themost common congenital anomaly of the gastro-intestinal tract, occurring in 2%–3% of the popu-lation (25,26). The diverticulum usually occurswithin 60 cm of the ileocecal valve on the an-timesenteric side of the bowel and can be up to 8cm in length. Its tip may be attached to the umbil-icus, and about two-thirds of diverticula containectopic gastric mucosa. Patients most commonlypresent with gastrointestinal hemorrhage, al-though intussusception and diverticulitis canalso occur.

Johann Friedrich Meckel, the Younger (1781–1833) (Fig 19), was born in Halle, Germany, to afamily of distinguished anatomists. He receivedhis medical degree from the University of Halle.While on a tour of the great medical centers ofEurope, he was forced to hurry home to preservehis family’s extensive anatomic collection whenFrench soldiers commandeered the family homeas Napoleon’s temporary headquarters. After thewar, he succeeded his father as Chairman of theDepartments of Surgery and Pathological Anat-omy at the University of Halle. Meckel was not

Figures 18, 19. (18) Meckel diverticulum containingstones. (a) Image from a small bowel examination showsdiscoid calcifications (arrow) in the right upper abdomen.(b) Another image from the same examination shows aMeckel diverticulum (arrow) containing stones and con-trast material. (19) Johann Friedrich Meckel, the Younger(1781–1833). (From the National Library of Medicine.)


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the first to describe the enteric diverticulum thatbears his name, nor was he the first to recognize itas a remnant of the vitelline duct. However, hismeticulous description of its embryonic originfixed his name to it. Meckel was forced to retire at50 years of age after developing severe paranoiaand died a recluse 2 years later (27).

Colon

Hirschsprung DiseaseHirschsprung disease (Fig 20), or colonic agangli-onosis, is a functional colonic obstruction result-ing from the failure of neural crest cells to migratethe entire length of the gastrointestinal tract. Al-though the rectum is always involved, involve-ment of the more proximal colon varies as theneural crest cells migrate distally. Hirschsprungdisease occurs in about one in every 5,000 livebirths, and 80% of cases manifest during the neo-natal period. Barium enema examination is theimaging study of choice. The most common find-ing is a transition zone between a normal or nar-rowed aganglionic distal segment that is free ofstool and a dilated, stool-filled proximal segment(28).

Harald Hirschsprung (1830–1916) (Fig 21)was the firstborn son of a successful cigar manu-facturer in Copenhagen, Denmark. However, he

Figures 20, 21. (20) Hirschsprung disease in anadult patient. (a) Abdominal radiograph shows amarkedly dilated bowel loop in the central abdo-men. (b) Image from a barium enema examinationshows marked sigmoid dilatation. The caliber of therectum is much smaller than normal. A discretetransition zone (arrow) is also seen. (21) HaraldHirschsprung (1830–1916). (From the NationalLibrary of Medicine.)


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forewent the family business for a career in medi-cine. Hirschsprung became interested in pediat-rics after encountering six cases of tracheoesopha-geal fistula and, in 1877, was appointed Professorof Pediatrics in Copenhagen. He published exten-sively on pediatric conditions, including spinaldysraphism, hiatal hernia, and biliary atresia.However, he became a leader in pediatric surgerybecause of his work in congenital megacolon, in-tussusception, and pyloric stenosis. Hirschsprungwas a pioneer in advocating the use of hydrostaticpressure for reducing intussusception and cor-rectly predicted that treatment of pyloric stenosiswould require surgery.

Hirschsprung was not the first to describe thecondition that bears his name, but his experiencewith two cases led to a detailed description ofcongenital megacolon as a clinical entity (29).However, he failed to recognize that the cause ofmegacolon was the nondilated segment of distal

bowel, and it was not until later in the 20th cen-tury, after his death, that intestinal aganglionosiswas identified as the pathologic basis of the dis-ease (30).

Crypts of LieberkuhnThe crypts of Lieberkuhn (Fig 22) are the large,straight tubular glands of the colonic mucosa thatconsist of simple columnar epithelial cells and areresponsible for water and electrolyte reabsorptionas well as mucin production (31).

Johann Nathanael Lieberkuhn (1711–1756)(Fig 23) was born in Berlin and initially pursued acareer in theology. However, science was his truepassion, and, while studying medicine at LeidenUniversity, he became interested in the new fieldof microscopy. Lieberkuhn invented a device forilluminating specimens for microscopic examina-tion, ultimately leading to his description of thecrypt-like architecture of the colonic epithelium(32). However, to his contemporaries, his mostsignificant contribution was assembling a collec-tion of over 400 vascular tissue specimens (33).

Figures 22, 23. (22) Crypts of Lieberkuhn. Image from a barium enema examination shows very small outpouch-ings (arrows) in the distal transverse colon representing filling of normal mucosal glands. (23) Johann NathanaelLieberkuhn (1711–1756). (From the National Library of Medicine.)


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E coli ColitisE coli is one of the most studied and well-knownenteric bacteria. It is a common cause of urinarytract infections but can also be responsible forfood-borne illness. The O157:H7 strain of E coliwas identified in 1982 during an outbreak of se-vere bloody diarrhea related to the ingestion ofundercooked hamburger meat. This strain pro-duces a powerful toxin that can result in hemo-lytic uremic syndrome in young children and el-derly adults. In patients with E coli colitis andhemolytic uremic syndrome, abdominal radio-graphs and barium enema examination may show“thumbprinting,” a finding that represents sub-mucosal edema and hemorrhage (Fig 24) (28).

Theodor Escherich (1857–1911) (Fig 25) wasborn in Bavaria and studied medicine at severalinstitutions (as was common in his day), includ-ing the University of Wurzburg, where he focusedon pediatrics. Influenced by the work of RobertKoch (1843–1910), Escherich became skillful inthe new and growing field of bacteriology. In1886, he published a monograph on intestinalbacterial flora in infants, in which he described

several new organisms, including the one thatnow bears his name: Escherichia coli (34). Whileon the faculty at the University of Graz in Austria,Escherich studied nutrition in infants. His reputa-tion continued to grow, and he was appointedhead of St Anna Hospital in Vienna. However, hissuccessful career was abruptly ended at the age of53 years by a fatal stroke (35).

ConclusionsNumerous eponyms are encountered in radiologyof the digestive tract, and this two-part series is byno means comprehensive. However, familiaritywith many of these eponyms is important for ac-curate communication. Although some puristsmay argue against their use, eponyms serve as ameans of honoring those who have made impor-tant discoveries and observations. Acquiring alittle historical knowledge about these individualsbrings some humanity back into the science ofmedicine.

Figures 24, 25. (24) Hemolytic uremic syndrome resulting from E coli colitis in a pediatric patient. Abdominal ra-diograph shows marked colonic thumbprinting (arrows), a finding that is consistent with marked submucosal edema.(25) Theodor Escherich (1857–1911). (From the National Library of Medicine.)


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Suggested ReadingsDelong MF. Medical acronyms, eponyms & abbrevia-

tions. 4th ed. Los Angeles, Calif: Practice Manage-ment Information Corporation, 2002.

Firkin BG, Whitworth JA. Dictionary of medical ep-onyms. 2nd ed. New York, NY: Parthenon, 1996.

Forbis P, Bartolucci SL. Stedman’s medical eponyms.Philadelphia, Pa: Lippincott Williams & Wilkins,1998.

Marcucci L. Marcucci’s handbook of medical ep-onyms. Philadelphia, Pa: Lippincott Williams &Wilkins, 2001.

Morton LT. Morton’s medical bibliography: an anno-tated check-list of texts illustrating the history ofmedicine. 5th ed. Scolar Press/Ashgate, 1991.

Skinner HA. The origin of medical terms. 2nd ed. Bal-timore, Md: Williams & Wilkins, 1961.

Sloane SB. Medical abbreviations & eponyms. 2nd ed.Philadelphia, Pa: Saunders, 1997.

References1. The American Heritage Stedman’s Medical Dic-

tionary. Boston, Mass: Houghton Mifflin, 2002.2. von Zenker FA, von Ziemssen HW. Krankheiten

des Oesophagus. Leipzig, Germany: 1874.3. Haubrich WS. von Zenker of Zenker’s diverticu-

lum. Gastroenterology 2004;126:1269.4. Mallory GK, Weiss S. Hemorrhage from lacera-

tion of the cardiac orifice of the stomach due tovomiting. Am J Med Sci 1929;178:506.

5. Haubrich WS. Mallory and Weiss of the Mallory-Weiss syndrome. Gastroenterology 2001;3:541.

6. Herbella FA, Matone J, Del Grande JC. Eponymsin esophageal surgery. II. Dis Esophagus 2005;18:4–16.

7. Stead EA Jr. Soma Weiss: the characteristics thatmade us know he was a great man. Pharos AlphaOmega Alpha Honor Med Soc 1987;50:11–12.

8. Boerhaave H. Atrocis, nec descripti prius, morbiihistoria: secundum medicae artis leges conscripta.Leiden, the Netherlands: Lugduni BatavorumBoutesteniana, 1724.

9. Kidd M, Modlin IM. The luminati of Leiden:from Bontius to Boerhaave. World J Surg 1999;23:1307–1314.

10. Tan SY, Hu M. Hermann Boerhaave (1668–1738): 18th century teacher extraordinaire. Singa-pore Med J 2004;45:3–5.

11. Schatzki R, Gary JE. Dysphagia due to a dia-phragm-like localized narrowing in the loweresophagus (“lower esophageal ring”). Am J Roent-genol Radium Ther Nucl Med 1953;70:911–922.

12. Eckardt VF, Kanzler G, Willems D. Single dila-tion of symptomatic Schatzki rings: a prospectiveevaluation of its effectiveness. Dig Dis Sci 1992;37:577–582.

13. Fass R. Distinct phenotypic presentations of gas-troesophageal reflux disease: a new view of thenatural history. Dig Dis 2004;22:100–107.

14. Chen MY, Frederick MG. Barrett esophagus andadenocarcinoma. Radiol Clin North Am 1994;32:1167–1181.

15. Barrett NR. Chronic peptic ulcer of the oesopha-gus and ‘oesophagitis’. Br J Surg 1950;38:175–182.

16. Spechler SJ, Goyal RK. The columnar-linedesophagus, intestinal metaplasia, and NormanBarrett. Gastroenterology 1996;110:614–621.

17. Zollinger RM, Ellison EH. Primary peptic ulcer-ations of the jejunum associated with islet cell tu-mors of the pancreas. Ann Surg 1955;142:709–728.

18. Fiely D, Ellison EC. The wit and wisdom of mas-ter surgeon Robert Zollinger: 1985. Am J Surg2003;186:242–244.

19. Tompkins RK. A giant with a gentle side. Surgery2003;134:509–510.

20. Menetrier P. Des polyadenomes gastrique et deleurs rapport avec le cancer de l’estomac. Archivesde Physiologie Normale et Pathologique 1888;1:236.

21. Olmsted WW, Cooper PH, Madewell JE. Involve-ment of the gastric antrum in Menetrier’s disease.AJR Am J Roentgenol 1976;126:524–529.

22. Haubrich WS. Menetrier of Menetrier’s disease.Gastroenterology 2002;123:1414.

23. Carman RD, Miller A. The Roentgen diagnosis ofdiseases of the alimentary canal. Philadelphia, Pa:Saunders, 1917.

24. Brown LR. A tribute to Russell Daniel Carman.Mayo Clin Proc 1995;70:1215–1217.

25. Rossi P, Gourtsoyiannis N, Bezzi M, et al. Meck-el’s diverticulum: imaging diagnosis. AJR Am JRoentgenol 1996;166:567–573.

26. Meckel JF. Traite general d’anatomie comparee.Paris, France: 1828.

27. Haubrich WS. Meckel of Meckel’s diverticulum.Gastroenterology 1998;114:542.

28. Parker B. Colon. In: Kuhn JP, Slovis TL, HallerJO, eds. Caffey’s pediatric diagnostic imaging.Philadelphia, Pa: Mosby, 2004; 1657–1662.

29. Hirschsprung H. Stuhltragheit Neugeborener inFolge von Dilatation und Hypertrophie des Co-lons. Jahrbuch fur Kinderheilkunde und physischeErziehung 1888;27:1–7.

30. Jay V. Legacy of Harald Hirschsprung. PediatrDev Pathol 2001;4:203–204.

31. Ross MH, Romrell LJ, Kaye GI. Histology: a textand atlas. 3rd ed. Baltimore, Md: Williams &Wilkins, 1995.

32. Lieberkuhn JN. Disseratio de fabrica et actionevillorum intestinorum tenuium hominis. Leiden,the Netherlands: Wishof, 1745.

33. Haubrich WS. Lieberkuhn of the crypts of Lieber-kuhn. Gastroenterology 2003;124:7.

34. Escherich T. Die Darmbakterien des Sauglingsund ihre Beziehungen zur Physiologie der Ver-dauung. Stuttgart, Germany: 1886.

35. Haubrich WS. Escherich of Escherichia coli. Gas-troenterology 2002;122:54.


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