Ultrasound Differential for Painless Vision Changes

A. Retinal Detachment

(1) Presentation:

•

Acute onset of unilateral floaters and/or pinpoint flashing lights (photopsias)

•

Can have visual loss or visual field cuts

(2) Note

: 외상에 의해 발생할 수도 있지만 더 흔하게는 자발적으로 발생하거나 전신적 질병 (예; vasculopathies)에 이차적으로 발생한다.

(3) Findings

: Posterior chamber에 hyperechoic한 linear 구조물이 posterir choroid와 분리되어 관찰됨

: 분리된 구조물은 중심으로는 optic nerve에 붙어 있음 (retina는 optic nerve의 연장이다)

(4) 진단 정확도

Sensitivity 75%, Specificity 94%, Positive Likelihood Ratio 12.4, Negative Likelihood Ratio 0.27 (Kim 2019, PMID: 29774966)

B. Vitreous Detachment

(1) Presentation

•

급성으로 비문증(visualization of floaters)이 한쪽으로 발생

•

Can have visual loss or visual field cuts

(2) Note

This is a common cause of retinal detachment

(3) Findings

: Hyperechoic linear floating structure often with increased echogenicity between the structure and the posterior surface of the globe

(4) Note

: Similar in appearance to retinal detachment but will not be tethered to the optic disc

(5) 진단정확도

Sensitivity 80.9%, Specificity 33.3% (Woo 2016, PMID: 27769323)

Vitreous Detachment – Source: Dr. Matt Riscinti and Dr. Bryan Flores,http://www.thepocusatlas.com/orbital

C. Vitreous Hemorrhage

(1) Presentation

•

Sudden painless visual loss or visual “haze”

•

Can be spontaneous or secondary to trauma

(2) Findings

: Swirling, slightly hyperechoic, “washing machine” appearing material in the posterior chamber

(3) Note

: You may have to increase the gain to adequately visualize. Prompting the patient to move the eye side to side will demonstrate swirling

(4) 진단 정확도

Sensitivity 43%, Specificity 93.8% (Woo 2016, PMID: 27769323)

• Note: Each of these ocular pathologies can appear alone or in combination and can be difficult to differentiate. All three will require ophthalmologic consultation.

Source WikiEM https://wikem.org/w/images/Image.png