IOTW 10/20/20

54M p/w left eye curtain-down vision loss preceded by 5 days of flashes and floaters

  1. What structure is indicated by label “A”?
    • Eyelid. To perform this study, copious gel is placed over the patient’s eye while their eyelid is closed. Thus the first structure seen nearest the footprint is the eyelid.
  2. What structure is indicated by label “B”?
    • Cornea.
  3. What structure is indicated by label “C”?
    • Iris and ciliary bodies.
  4. What is indicated by label “D”?
    • Pupil.
  5. What structure is indicated by label “E”?
    • Posterior capsule of the lens.
  6. What chamber is located between labels “B” and “C”?
    • Anterior chamber. The anterior segment is located between the cornea and lens. The anterior chamber of the anterior segment is located between the cornea and iris. The posterior chamber of the anterior segment is located between the iris and lens. These are both filled with aqueous humor.
  7. What chamber is indicated by label “F”?
    • Vitreous chamber. This is also known as the posterior segment.
  8. What structure is indicated by label “G”?
    • Optic nerve within optic nerve sheath.
  9. What is the diagnosis indicated by label “H”?
    • Retinal detachment (with some vitreous debris).
      • Your primary differential for a hyperechoic curvilinear structure running along the edge within the vitreous chamber is: posterior vitreous detachment, retinal detachment, or choroid detachment.
      • The vitreous layer is the innermost of these 3 layers. When detached, it is often fairly thin (best visualized with high gain settings), can be seen crossing the macula, and is mobile with oculokinetic movements.
      • The retina is located between the vitreous and choroid layers. When detached, it can be visualized inserting into the macula at the optic disk and is also mobile with oculokinetic movements.
      • The choroid is located between the retina and sclera. When detached, it appears as a thick echogenic pair of bands that remain fixed with oculokinetic movements.
  10. BONUS: What is being measured in the final image and what diagnosis does this exclude?
    • Presence of arterial flow over the central retinal artery. When a patient presents with symptoms concerning for amaurosis fugax, central retinal artery occlusion should be highly considered on your differential. Presence of adequate arterial flow over the central retinal artery excludes this diagnosis. .

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