Dx: Ruptured Vessel

The ultrasound image shows a view of the globe with the retina at the bottom of the image. The vitreous humor appears anechoic (black) and the retina echoic (gray). Just in front of the retina is a small echoic area that was not present in the unaffected eye. It does not appear to be connected to the retina, making it a bit atypical in appearance for a retinal detachment. A vitreous detachment could also look like this on ultrasound, but would also be attached at some point to the posterior globe. Examination by ophthalmology with his fancy gadgets and unique skill set revealed that this echoic area seen on ultrasound was a collection of blood from a subhyaloid hemorrhage. The patient ruptured a retinal blood vessel during her hard coughing fits the night before. Remember that the hyaloid border is basically the outer edge of the vitreous humor. There was also a small amount of vitreous hemorrhage that had occurred, which impaired visualization of the retina with the ED ophthalmoscope. The patient was able to be discharged home with limited activity and recheck with the ophthalmologist in two days. At the time of publication, her vision is still impaired, but gradually recovering. Brady Pregerson (@TheSafetyDoc) manages a free online EM Ultrasound Image Library and is the editor of the Emergency Medicine Pocketbook series. For more info visit EMresource.ORG. Teresa S. Wu (@TeresaWuMD) is the Associate Residency Director, and Director of Ultrasound and Simulation Programs and ...
Source: EPMonthly.com - Category: Emergency Medicine Authors: Tags: Uncategorized Source Type: news