Eponymous Triads
Medical triads, tetrads, and pentads are shorthand diagnostic groupings which combine sets of three, four, or five characteristic clinical features. These clusters of signs, symptoms, or pathological findings serve as memorable patterns that help recognise, recall, and communicate specific conditions.
PENTADS
TETRADS
TRIADS
Amyand’s triad
- Amyand’s hernia
- Appendicitis
- Undescended testis
Coined by Dhanasekarapandian et al in 2018 who published the case of a 35-day-old infant with an irreducible right inguinal hernia, inflamed appendix, and gangrenous undescended testis managed by appendicectomy, orchidectomy, and herniotomy.
- Claudius Amyand (c.1680-1740) was an French-born English surgeon
- Dhanasekarapandian V, Shanmugam V, Jagannathan M. Amyand’s Hernia, Appendicitis, and Undescended Testis: The Amyand’s Triad. J Indian Assoc Pediatr Surg. 2018 Jul-Sep;23(3):169-170.
Charcot’s Triad
Dieulafoy’s Triad (Appendicitis) [Triade de Dieulafoy]
Triad of physical findings indicating acute appendicitis outlined by Dieulafoy to differentiate appendicitis from intestinal lithiasis and other causes of abdominal pain.
- Tenderness at McBurney’s point (douleur au point de Mac-Burney)
- Cutaneous hyperaesthesia (hyperesthésie cutanée)
- Involuntary muscular guarding (défense musculaire)
Original
English
Au cas d’appendicite, le territoire abdominal cutané, qui correspond à la zone douloureuse sous-jacente, est le siège d’une hyperesthésie caractéristique et le plan musculaire abdominal est tendu, douloureux, contracturé au point de Mac-Burney…c’est à cette région que se localisent l’hyperesthésie cutanée et la défense musculaire, qui sont des éléments précieux de diagnostic.- Dieulafoy 1898
In cases of appendicitis, the abdominal cutaneous area, which corresponds to the underlying painful area, is the site of characteristic hyperaesthesia, and the abdominal muscles are tense, painful, and contracted at the MacBurney point…it is in this region that cutaneous hyperaesthesia and muscular guarding are located, which are valuable diagnostic elements. – Dieulafoy 1898
- Georges-Paul Dieulafoy (1839-1911) was a French Clinician
- Dieulafoy G. Lithiase intestinale et entéro-colite. Clinique médicale de l’Hôtel-Dieu de Paris, 1898: I: 296 [trois signes caractéristiques de l’appendicite]
Dieulafoy’s Triad (functional blindness)
Triad suggestive of functional/hysterical blindness described by Dieulafoy in his clinical lectures at Hôtel-Dieu de Paris.
- Sudden onset of blindness (cécité à début brusque)
- Preserved pupillary light reflexes (conservation des réflexes pupillaires)
- Normal fundoscopic exam (intégrité du fond de l’œil)
Original
English
Cécité complète à début brusque, conservation du réflexe pupillaire à la lumière et intégrité du fond de l’œil… ces constatations répondaient au syndrome que je désigne du nom de ‘triade symptomatique de la cécité hystérique.’ – Dieulafoy 1904
Complete blindness with sudden onset, preservation of the pupillary light reflex, and integrity of the fundus… these findings corresponded to the syndrome that I call the ‘symptomatic triad of hysterical blindness.’ – Dieulafoy 1904
Confirmed and cited by Crouzon (1915) in wartime neuropsychiatric observations of sudden blindness without organic findings. Multiple cases published e.g. cécité temporaire provoquée par l’éclatement d’obus à proximité
- Georges-Paul Dieulafoy (1839-1911) was a French Clinician
- Dieulafoy G. Deux case de cécité hystérique. Clinique Médicale de l’Hôtel-Dieu de Paris, 1904; V: 75 [triade symptomatique de la cécité hystérique]
Merseburger Triad
Moschcowitz triad (pericardial effusion)
In 1933 Moschcowitz published A new sign of pericardial effusion, in which he described three physical examination findings that, when present together, are indicative of pericardial effusion:
- Widening of the area of cardiac dullness.
- Abrupt transition from pulmonary resonance to cardiac dullness.
- Extension of cardiac dullness into the second intercostal space
I have found that the conjunction of three signs is usually conclusive in determining the diagnosis of pericardial effusion; in the order of their importance, they are: (1) widening of the area of cardiac flatness, (2) abrupt transition from pulmonary resonance to cardiac flatness and (3) widening of the cardiac dullness in the second intercostal space. No one of these signs, taken singly, is conclusive, but together they form a triad which is thoroughly reliable, as confirmed by roentgen examination or at autopsy.
Moschcowitz 1933
Moschcowitz emphasized that while each sign individually might not be conclusive, their combination provides a reliable diagnostic indicator for pericardial effusion, as confirmed by roentgen examination or autopsy
- Eli Moschcowitz (1879-1964) was a Hungarian born, American pathologist and physician
- Moschcowitz E. A new sign of pericardial effusion. JAMA. 1933; 100(21):1663-1664
Quincke’s triad (hemobilia)
- Right hypochondrium pain
- Jaundice
- Gastrointestinal bleeding (haematemesis and melena)
In 1871, Heinrich Quincke published a detailed case of hepatic artery aneurysm rupture leading to bleeding into the biliary tree. He associated three cardinal features now recognised as Quincke’s triad:
Original
English
Die Krankheit begann…mit Kolik, Erbrechen und etwas Blutbeimengung im Stuhl… Der Kranke war bleich, hatte leichten Ikterus… gegen Abend Bluterbrechen…Wiederholte Blutungen aus dem Magen und schwarzer Stuhl wechselten mit Gelbsucht und Schmerzanfällen im rechten Hypochondrium – Quincke 1871
The illness began…with colic, vomiting and some blood in the stool…The patient was pale, had slight jaundice…in the evening he vomited blood…Repeated bleeding from the stomach and black stools alternated with jaundice and attacks of pain in the right hypochondrium – Quincke 1871
1975 – Eddy Davis Palmer, (1917-2010) first documented use of the term Quincke’s triad of hemobilia in the second edition of his textbook Practical Points in Gastroenterology as:
Quincke’s triad of hemobilia consists of GI hemorrhage, biliary colic, and jaundice.
- Heinrich Irenaeus Quincke (1842-1922) was a German physician
- Quincke H. Ein fall von Aneurysma der Leberarterie. Berliner Klinische Wochenschrift 1871; 8: 349-352 [Hepatic artery aneurysm. Described triad of biliary tract haemorrhage]
Reidel’s Triad
Saint’s Triad
Virchow’s Triad
Whipple’s triad
eponymythology
the myths behind the names
