Ultrasound Case 028

Presentation

A 55 year old diabetic woman presents with painless loss of monocular vision. You wonder whether ultrasound will show a retinal detachment.


Describe and interpret these scans

IMAGE INTERPRETATION

Image 1: Transverse ocular ultrasound, patient looking right then left.

The posterior chamber is filled by swirling echogenic debris. This is a large amount of vitreous haemorrhage. The gelatinous liquid vitreous has detached and blood lies within and behind the collapsed vitreous.

The retina appears intact in this limited view. Whilst detachment is relatively easily see a retinal tear is not seen well with ultrasound. The optic nerve can be seen posteriorly. The anterior chamber is not well visualised – the transducer was placed superior to it.


CLINICAL CORRELATION

Vitreous haemorrhage.

Vitreous haemorrhage is not often as extensive as this, and smaller areas of the cloudy appearing swirling blood are more commonly seen.

In this case the extensive haemorrhage prevented ophthalmoscopic examination of the retina and we were asked to ensure there was not a large associated retinal detachment.

With retinal detachment a thicker detached membrane is seen, moving with eye movement but not swirling as freely as seen here. In addition retinal detachment never occurs at the optic nerve where retinal fibers run posteriorly into the optic nerve and anchor the retina at this point.


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An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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