Diagnosis of complicated gynaecological inflammations by computed tomography - one center experience.

The aim of this article is to acquaint the gynaecological public with our experience with the use of computed tomography in the diagnosis of fluid collections in women with clinical suspicion of complicated pelvic inflammation or a complication after gynaecological surgery. We present diagnostic dilemmas that radiologists deal with, including differential diagnoses. We also deal with the benefits for the referring gynaecologist, and we also discuss the possible discrepancy between his expectations and the result of the examination.

A Need for Standardization of the Diagnosis and Treatment of Pelvic Inflammatory Disease: Pilot Study in an Outpatient Clinic in Quito, Ecuador.

Background: Pelvic inflammatory disease (PID) diagnosis is often challenging as well as its treatment. This study sought to characterize the diagnostic and therapeutic trend among physicians at the outpatient level, in Quito, Ecuador, where currently no nationwide screening or specific clinical guideline has been implemented on PID or its main microbiological agents. Methods: A retrospective analysis of medical records with pelvic inflammatory disease diagnosis in an outpatient clinic was performed. Electronic medical records from 2013 to 2018 with any pelvic inflammatory disease-related diagnoses were retrieved. Information with regard to age, sexually related risk factors, symptoms and physical exam findings, ancillary tests, method of diagnosis, and antibiotic regimens was extracted. Results: A total of 186 records were included. The most frequent clinical manifestations were vaginal discharge (47%) and pelvic pain (39%). In the physical examination, leucorrhea was the most frequent finding (47%), followed by lower abdominal tenderness (35%) and cervical motion tenderness in 51 patients (27%). A clinical diagnosis was established in 60% of patients, while 37% had a transvaginal sonography-guided diagnosis. Antibiotic treatment was prescribed with standard regimens in 3% of cases, while other regimens were used in 93% of patients. Additionally, an average of 1.9 drugs were prescribed per patient, with a range from 1 to 5, all in different combinations and dosages. Conclusions: No standardized methods of diagnosis or treatment were identifiable. These findings highlight the need for standardization of the diagnosis and treatment of PID attributed to chlamydial and gonococcal infections.

MRI of acute appendicitis.

Appendicitis is the most common cause of acute abdominal pain resulting in surgery. While historically ultrasound (US) and computed tomography (CT) have been used to evaluate for appendicitis and its related complications, magnetic resonance imaging (MRI) has become a highly accurate and increasingly utilized modality in the last two decades, particularly in the pediatric and pregnant patient populations in whom ionizing radiation is used reluctantly. This article discusses the advantages and disadvantages of MRI as a modality to evaluate for acute appendicitis, summarizes studies of the diagnostic performance relative to CT and US, provides a standard MR protocol, and describes MRI findings typical of acute appendicitis, common complications, and other differential diagnoses. Level of Evidence: 2 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:1367-1376.

Acute pelvic inflammatory disease as a rare cause of acute small bowel obstruction.

Introduction: Small bowel obstruction (SBO) is a common presentation to emergency abdominal surgery. The most frequent causes of SBO are congenital, postoperative adhesions, abdominal wall hernia, internal hernia and malignancy. Patients: A 27-year-old woman was hospitalized because of acute abdominal pain, blockage of gases and stools associated with vomiting. Abdominal computed tomography showed an acute small bowel obstruction without any obvious etiology. In view of important abdominal pain and the lack of clear diagnosis, an explorative laparoscopy was performed. Diagnostic of pelvic inflammatory disease was established and was comforted by positive PCR for Chlamydia Trachomatis. Results: Acute small bowel obstruction resulting from acute pelvic inflammatory disease, emerging early after infection, without any clinical or X-ray obvious signs was not described in the literature yet. This infrequent acute SBO etiology but must be searched especially when there is no other evident cause of obstruction in female patients. Early laparoscopy is mostly advised when there are some worrying clinical or CT scan signs.

Tubal Disease and Impersonators/Masqueraders.

Ultrasound is considered the first-line imaging modality in the evaluation of the fallopian tubes. This chapter reviews both the physiologic and pathologic sonographic findings of the fallopian tubes and how to recognize characteristic entities. Specifically, it describes how to use ultrasound techniques to distinguish between pathologic processes including chronic versus acute pelvic inflammatory disease, as well as infertility, torsion, and malignancy. It also describes how to employ modern ultrasound techniques, such as color Doppler, three-dimensional imaging, and salpingocentesis in clinical practice.

MDCT of pelvic inflammatory disease: a review of the pathophysiology, gamut of imaging findings, and treatment.

Representing an ascending, sexually spread pyogenic infection of the female genital tract, pelvic inflammatory disease (PID) is a commonly encountered cause for emergency visits and hospitalizations among young and adult female patients. Though gynecologic evaluation and sonography constitute the mainstay of diagnosis, multidetector CT imaging of the abdomen and pelvis is not uncommonly performed, often as the initial imaging modality, due to the frequently vague and indeterminate clinical presentation. As such, knowledge and attenuation to the often subtle early imaging features of PID afford the radiologist a critical chance to direct and expedite appropriate pathways of patient care, minimizing the risk for secondary complications, including infertility, ectopic pregnancy, and enteric adhesions. In this paper, we will review the pathophysiology, clinical presentation, early and late imaging features of PID as well as potential secondary complications and treatment options. Additionally, we will discuss published data metrics on CT performance regarding sensitivity and specificity for diagnosis as well as potential imaging differential diagnostic considerations.

[Tubo-ovarian abscess in the 39th week of pregnancy (case report)]. / Tuboovariální absces ve 39. týdnu gravidity (kazuistika).

OBJECTIVE: A case of tubo-ovarian abscess in a patient with term pregnancy. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Nemocnice s poliklinikou Karviná Ráj. CASE REPORT: I hereby report a case of a patient in her 39th week of pregnancy hospitalized for abdominal pain and vomiting. Due to unclear aetiology and growing dynamics of inflammatory markers the ending of the pregnancy by induction of labour was indicated. Postpartum examination performed through computed tomography determines the cause of current problems. Conservative therapy of the diagnosed adnexal abscess, however, is insufficient. In the fourth postpartum day, the patient is indicated for surgical intervention and unilateral salpingo oophorectomy is performed. CONCLUSION: Even though rare during this period, some forms of clinical pelvic inflammatory disorders during pregnancy have to be taken into consideration. Timely and correct diagnosis combined with adequate therapy is of vital importance for reduction of perinatal and maternal mortality and morbidity.

Pelvic Inflammatory Disease: Multimodality Imaging Approach with Clinical-Pathologic Correlation.

Pelvic inflammatory disease (PID) is a common medical problem, with almost 1 million cases diagnosed annually. Historically, PID has been a clinical diagnosis supplemented with the findings from ultrasonography (US) or magnetic resonance (MR) imaging. However, the diagnosis of PID can be challenging because the clinical manifestations may mimic those of other pelvic and abdominal processes. Given the nonspecific clinical manifestations, computed tomography (CT) is commonly the first imaging examination performed. General CT findings of early- and late-stage PID include thickening of the uterosacral ligaments, pelvic fat stranding with obscuration of fascial planes, reactive lymphadenopathy, and pelvic free fluid. Recognition of these findings, as well as those seen with cervicitis, endometritis, acute salpingitis, oophoritis, pyosalpinx, hydrosalpinx, tubo-ovarian abscess, and pyometra, is crucial in allowing prompt and accurate diagnosis. Late complications of PID include tubal damage resulting in infertility and ectopic pregnancy, peritonitis caused by uterine and/or tubo-ovarian abscess rupture, development of peritoneal adhesions resulting in bowel obstruction and/or hydroureteronephrosis, right upper abdominal inflammation (Fitz-Hugh-Curtis syndrome), and septic thrombophlebitis. Recognition of these late manifestations at CT can also aid in proper patient management. At CT, careful assessment of common PID mimics, such as endometriosis, adnexal torsion, ruptured hemorrhagic ovarian cyst, adnexal neoplasms, appendicitis, and diverticulitis, is important to avoid misinterpretation, delay in management, and unnecessary surgery. Correlation with the findings from complementary imaging examinations, such as US and MR imaging, is useful for establishing a definitive diagnosis. (©)RSNA, 2016.

Diagnosis and Management of Adnexal Masses.

Adnexal masses can have gynecologic or nongynecologic etiologies, ranging from normal luteal cysts to ovarian cancer to bowel abscesses. Women who report abdominal or pelvic pain, increased abdominal size or bloating, difficulty eating, or rapid satiety that occurs more than 12 times per month in less than a year should be evaluated for ovarian cancer. Pelvic examination has low sensitivity for detecting an adnexal mass; negative pelvic examination findings in a symptomatic woman should not deter further workup. Ectopic pregnancy must be ruled out in women of reproductive age. A cancer antigen 125 (CA 125) test may assist in the evaluation of an adnexal mass in appropriate patients. CA 125 levels are elevated in conditions other than ovarian cancer. Because substantial overlap in CA 125 levels between pre- and postmenopausal women may occur, this level alone is not recommended for differentiating between a benign and a malignant adnexal mass. Transvaginal ultrasonography is the first choice for imaging of an adnexal mass. Large mass size, complexity, projections, septation, irregularity, or bilaterality may indicate cancer. If disease is suspected outside of the ovary, computed tomography may be indicated; magnetic resonance imaging may better show malignant characteristics in the ovary. Serial ultrasonography and periodic measurement of CA 125 levels may help in differentiating between benign or potentially malignant adnexal masses. If an adnexal mass larger than 6 cm is found on ultrasonography, or if findings persist longer than 12 weeks, referral to a gynecologist or gynecologic oncologist is indicated.

Does the Degree of Perihepatitis Have Any Relevance to the Severity of the Manifestations of Pelvic Inflammatory Disease on Multidetector Computed Tomography?

PURPOSE: This study aimed to evaluate the relationship between the degree of perihepatitis and the severity of pelvic inflammatory disease (PID) on multidetector computed tomography (MDCT). METHODS: A total of 177 women with PID who underwent biphasic abdominal computed tomography (CT) scans were enrolled. Two reviewers retrospectively reviewed the CT scans with consensus and subjectively categorized the severity of PID into 4 grades (normal, mild, moderate, and severe). Another reviewer independently assigned the extent (grades 0 to 4) and the depth (grades 0 to 4) of hepatic surface enhancement in terms of the degree of perihepatitis. Relationships between the degree of perihepatitis and the CT severity as well as each CT manifestation of PID were evaluated using the χ test or a cumulative logistic regression analysis. RESULTS: Of the 177 patients, 99 (55.9%) showed hepatic surface enhancement. The severity of PID on MDCT was significantly related with the degree of perihepatitis (all P < 0.001). Salpingitis, oophoritis, pelvic fat haziness, complicated ascites, and omental/mesenteric fat infiltration were significantly related with the degree of perihepatitis (all P < 0.05). Among these variables, omental/mesenteric fat infiltration (odds ratio = 10.9) and salpingitis (odds ratio = 6.0) were the CT manifestations that were most associated with the presence of perihepatitis in PID. CONCLUSIONS: The degree of perihepatitis seems to show a relationship with the severity of PID on MDCT. Omental/mesenteric fat infiltration and salpingitis can be strongly related with perihepatitis in PID.

A rare and unexpected case of retained foetal bone after an unsafe abortion.

Unsafe abortion is one of the most neglected healthcare problems in developing countries. One of the rare complications of unsafe abortion is retained foetal bone. Prevalence of disease is around 0.15% among patients undergoing diagnostic hysteroscopy. Patients have no specific symptoms. Case reports have focused on subfertility, abnormal uterine bleeding, lower abdominal pain, abnormal vaginal discharge, dyspareunia, dysmenorrhoea and spontaneous passage of bony fragments. Retained foetal bone fragments may cause acute pelvic inflammatory disease in rare cases regardless of the time interval after abortion. This condition can also present as recurrent vagitinis or endometritis refractory to ampirical antimicrobial treatment. In such cases, foreign body in uterine cavity should be kept in mind. Such patients should primarily be evaluated by ultrasonography which has substantial clinical importance in differential diagnosis of these cases. We present a case of misdiagnosed retained foetal bone complicated with recurrent vaginal discharge and acute pelvic inflammatory disease.

CT findings of acute pelvic inflammatory disease.

PURPOSE: To determine the computed tomographic (CT) findings of acute pelvic inflammatory disease (PID). METHODS: This retrospective, single-institution case-control study was approved by our institutional review board, and the informed consent was waived owing to the retrospective nature of the study. CT images of 32 women with clinically proven acute PID and 32 control subjects with other conditions of similar presentation were retrospectively reviewed. Analysis of CT findings included hepatic capsular enhancement, pelvic fat haziness, complicated ascites, uterine serosal enhancement, tubal thickening, endometritis, and oophoritis. Comparison of CT findings was performed with the Chi square test or the Fisher exact test and logistic regression analysis was used to determine significant CT findings in predicting PID. RESULTS: The CT findings that showed a statistically significant difference were hepatic capsular enhancement on late arterial phase (p = 0.003), pelvic fat haziness (p = 0.045), and tubal thickening (p = 0.001). Subsequent multivariate logistic regression analysis revealed that the presence of hepatic capsular enhancement on late arterial phase and tubal thickening were significant predictors of PID (hepatic capsular enhancement on late arterial phase, p = 0.015, odds ratio [OR] = 4.8; tubal thickening, p = 0.005, OR = 10.5). CONCLUSION: Diagnostic morphological CT findings in women with clinically proven PID and acute abdominal pain include hepatic capsular enhancement on late arterial phase and tubal thickening.

The sensitivity and specificity of transvaginal ultrasound with regard to acute pelvic inflammatory disease: a review of the literature.

PURPOSE: This review aims to sum up current knowledge on the sensitivity and specificity of ultrasound features suggestive of acute pelvic inflammatory disease (PID). METHODS: A PubMed database search was undertaken, using the MeSH terms "(pelvic inflammatory disease or salpingitis or adnexitis) and ultrasonography". We included original articles evaluating the performance of vaginal ultrasound in detecting acute PID. RESULTS: Seven articles were selected, including between 18 and 77 patients each. The golden standard used was laparoscopy/endometrial biopsy in six studies and mostly clinical evaluation in one. "Thick tubal walls" proved to be a specific and sensitive ultrasound sign of acute PID, provided that the walls of the tubes can be evaluated, i.e., when fluid is present in the tubal lumen (100 % sensitivity). The cogwheel sign is also a specific sign of PID (95-99 % specificity), but it seems to be less sensitive (0-86 % sensitivity). Bilateral adnexal masses appearing either as small solid masses or as cystic masses with thick walls and possibly manifesting the cogwheel sign also seems to be a reasonably reliable sign (82 % sensitivity, 83 %specificity). Doppler results overlap too much between women with and without acute PID for them to be useful in the diagnosis of acute PID, even though acutely inflamed tubes are richly vascularized at color Doppler. CONCLUSIONS: Even though the results of our review suggest that transvaginal ultrasound has limited ability to diagnose acute PID, it is likely to be helpful when managing women with symptoms of acute PID, because in some cases the typical ultrasound signs of acute PID can be detected.

Transvaginal ultrasound assessment of women presenting with infertility and menstrual irregularity in Calabar, Nigeria.

AIMS AND OBJECTIVES: This study was designed to document the Transvaginal Scan (TVS) findings in women presenting with infertility and menstrual irregularities at the University of Calabar Teaching Hospital. MATERIALS AND METHODS: Subjects were women of reproductive age presenting at the University of Calabar Teaching Hospital with menstrual irregularities and infertility over a two year period, February 2011-January 2013. As part of their management, transvaginal scans were done and findings included a substantial number with polycystic ovarian cysts. Therefore the ovaries were further analysed with controls. RESULTS: Out of seventy-one women with age distribution of 22 to 46years, twenty- four(33.8%) presented with infertility, the rest presented with either menstrual irregularity alone or in combination with infertility. Polycystic ovaries (PCO), chronic pelvic inflammatory disease and fibroids were the main pathologies seen. PCO was by far the commonest. Ovarian volumes and follicular numbers were significantly higher in women with PCO than in controls, whereas their average follicular sizes were lower. CONCLUSION: PCO is the major finding in women with menstrual irregularity and infertility in the Calabar area. This hitherto poorly recorded pathology should be actively investigated in women representing with these symptoms by the use of TVS.

Perihepatitis as an Initial Manifestation of Systemic Lupus Erythematosus.

A 25-year-old man presented with a fever and right upper quadrant abdominal pain. Computed tomography (CT) of the abdomen revealed diffuse perihepatic capsular enhancement, suggesting perihepatitis. Although the patient was a man, Fitz-Hugh-Curtis syndrome was suspected based on the CT findings. Treatment with several antibiotics was ineffective. Urinary tract infection was ruled out due to negative urinary bacterial screening and careful history taking. He was finally diagnosed with systemic lupus erythematous (malar rash, pleuritis, positive antinuclear antibody, and positive anti-ds-DNA antibody). Perihepatitis resolved quickly with high-dose prednisolone. Perihepatitis may be the first manifestation of SLE.

"Can't Touch This!": Laparoscopic management of an obstructed uterus didelphys before and after treatment for pelvic inflammatory disease.

OBJECTIVE: To describe the laparoscopic management of an obstructed uterus didelphys before and after treatment for pelvic inflammatory disease. To compare the appearance of pelvic organs during active infection with their appearance after washout and appropriate antibiotic treatment, emphasizing the importance of knowing when to abort a procedure. DESIGN: Video demonstration of surgical and medical management considerations during a complex pelvic surgery. Visualization of tissue healing that occurs with appropriate antibiotic treatment. SETTING: Academic Center. PATIENT: A patient who presents for definitive surgical management of a uterus didelphys with an obstruction at her right hemicervix. Her presentation is complicated by a tubo-ovarian abscess. INTERVENTION: A uterus didelphys is classically defined as two hemiuteri with duplicated cervices with or without a longitudinal vaginal septum. Uterus didelphys may have an obstruction and/or communication between the two uterine horns, in which case patients may present with complications such as cyclic pelvic pain from hematometra or genital tract infection. This is a case report of a 14-year-old G0 who presented to the emergency department with two weeks of vaginal bleeding, severe diffuse abdominal pain, and malodorous vaginal discharge. Transabdominal ultrasound and a magnetic resonance imaging of the pelvis established a new diagnosis of a uterus didelphys with an obstruction at her right hemicervix and a fistulous tract connecting her right and left hemiuteri at the level of the internal cervical os. She was also found to have a 3 cm left ovarian cyst and a new finding of congenital absence of her right kidney. Patient was administered ceftriaxone, doxycycline, and metronidazole antibiotics as treatment of presumed pelvic inflammatory disease but experienced minimal improvement after 24 hours. The decision was made to proceed with surgical intervention. A survey of the pelvis revealed significant inflammation, friable peritoneum, and endometriosis. The uterine horns in didelphic configurations were visualized. The fimbriae at the left fallopian tube were notably splayed out, swollen, and inflamed. There was a notable large mass in the location where the ovarian cyst had been previously described on imaging. A large amount of purulent material was expressed when compressed, consistent with a tubo-ovarian abscess. The infection likely originated from the menstrual blood collection at the right obstructed cervix that ascended through the communication between the right and left hemiuteri. The pelvis was irrigated thoroughly. At this point, the decision was made to stop the procedure, pursue antibiotic treatment, and resolve the active infection before correcting her complex müllerian anomaly. Patient continued on her antibiotic course, which included piperacillin-tazobactam, while hospitalized, followed by a five-day course of amoxicillin-clavulanate. She was also placed on medroxyprogesterone acetate for menstrual suppression. MAIN OUTCOME MEASURE: Advantage of allowing time for antibiotic treatment and tissue healing before repair of a complex müllerian anomaly. RESULT: With antibiotic treatment, she recovered well postoperatively with resolution of her pain. Three months later, she returned to the operating room for definitive surgical management of her obstructed uterine didelphys. On laparoscopy, there was a significant improvement in tissue quality. Most notably, the fimbriae of the left fallopian tube were no longer inflamed. We proceeded with the planned correction of the complex müllerian anomaly. After resection of the right uterine horn, the fistula tract was identified and also resected. The defect in the right hemicervix was closed over, reinforcing the medial side of the left hemicervix. She had an uncomplicated postoperative recovery, and menses resumed without pain. CONCLUSIONS: The presented case provides unique insight into the tissue healing that occurs before and after antibiotic treatment. Knowing when to stop, especially in the setting of an active infection, is extremely important for performing a procedure safely, minimizing harm, and allowing for robust tissue repair. It is also important to optimize modifiable preoperative factors before correcting a complex müllerian anomaly. Assessing and reassessing the situation during a complex pelvic surgery is essential, especially in the setting of a complex müllerian anomaly where the preoperative examination and imaging may not be definitive.

Ultrasound for diagnosing acute salpingitis: a prospective observational diagnostic study.

STUDY QUESTION: What are the diagnostic benefits of using ultrasound in patients with a clinical suspicion of acute salpingitis and signs of pelvic inflammatory disease (PID)? SUMMARY ANSWER: In patients with a clinical suspicion of acute salpingitis, the absence of bilateral adnexal masses at ultrasound decreases the odds of mild-to-severe acute salpingitis about five times, while the presence of bilateral adnexal masses increases the odds about five times. WHAT IS KNOWN ALREADY: PID is difficult to diagnose because the symptoms are often subtle and mild. The diagnosis is usually based on clinical findings, and these are unspecific. The sensitivity and specificity of ultrasound with regard to salpingitis have been reported in one study (n = 30) of appropriate design, where most patients had severe salpingitis (i.e. pyosalpinx) or tubo-ovarian abscess. STUDY DESIGN, SIZE, DURATION: This diagnostic test study included 52 patients fulfilling the clinical criteria of PID. Patients were recruited between October 1999 and August 2008. PARTICIPANTS/MATERIALS, SETTING, METHODS: The patients underwent a standardized transvaginal gray scale and Doppler ultrasound examination by one experienced sonologist (index test) before diagnostic laparoscopy by a laparoscopist blinded to the ultrasound results. The final diagnosis was determined by laparoscopy, histology of the endometrium and other histology where relevant (reference standard). MAIN RESULTS AND THE ROLE OF CHANCE: Of the 52 patients, 23 (44%) had a final diagnosis unrelated to genital infection, while the other 29 had cervicitis (n = 3), endometritis (n = 9) or salpingitis (n = 17; mild n = 4, moderate n = 8, severe, i.e. pyosalpinx n = 5). Bilateral adnexal masses and bilateral masses lying adjacent to the ovary were seen more often on ultrasound in patients with salpingitis than with other diagnoses (bilateral adnexal masses: 82 versus 17%, i.e. 14/17 versus 6/35, P = 0.000, positive likelihood ratio 4.8, negative likelihood ratio 0.22; bilateral masses adjacent to ovary: 65 versus 17%, i.e.11/17 versus 6/35, P = 0.001, positive likelihood ratio 3.8, negative likelihood ratio 0.42). In cases of salpingitis, the masses lying adjacent to the ovaries were on average 2-3 cm in diameter, solid (n = 14), unilocular cystic (n = 4), multilocular cystic (n = 3) or multilocular solid (n = 1), with thick walls and well vascularized at colour Doppler. In no case were the cogwheel sign or incomplete septae seen. All 13 cases of moderate or severe salpingitis were diagnosed with ultrasound (detection rate 100%, 95% confidence interval 78-100%) compared with 1 of 4 cases of mild salpingitis. Three of six cases of appendicitis, and two of two ovarian cysts were correctly diagnosed with ultrasound, and one case of adnexal torsion was suspected and then verified at laparoscopy. LIMITATIONS, REASONS FOR CAUTION: The sample size is small. This is explained by difficulties with patient recruitment. There are few cases of mild salpingitis, which means that we cannot estimate with any precision the ability of ultrasound to detect very early salpingitis. The proportion of cases with salpingitis of different grade affects the sensitivity and specificity of ultrasound, and the sensitivity and specificity that we report here are applicable only to patient populations similar to ours. WIDER IMPLICATIONS OF THE FINDINGS: The information provided by transvaginal ultrasound is likely to be of help when deciding whether or not to proceed with diagnostic laparoscopy in patients with symptoms and signs suggesting PID and, if laparoscopy is not performed, to select treatment and plan follow-up.

Emergency radiology eponyms: part 2--Naclerio's V sign to Fournier gangrene.

An eponym is a name based on the name of a person, frequently as a means to honor him/her, and it can be used to concisely communicate or summarize a complex abnormality or injury. However, inappropriate use of an eponym may lead to potentially dangerous miscommunication. Moreover, an eponym may honor the incorrect person or a person who falls into disrepute. Despite their limitations, eponyms are still widespread in medicine. Many commonly used eponyms applied to extremity fractures should be familiar to most emergency radiologists and have been previously reported. Yet, a number of non-extremity eponyms can be encountered in an emergency radiology practice as well. This other group of eponyms encompasses a spectrum of traumatic and nontraumatic pathology. In this second part of a two-part series, the authors discuss a number of non-extremity emergency radiology eponyms, including relevant clinical and imaging features, as well biographical information of the eponyms' namesakes.