Ultrasound Appearance of Vitreous Hemorrhage
False. The classic appearance of vitreous hemorrhage on ultrasound is characterized by low-reflective, mobile, dot-like or particulate echoes that swirl freely within the vitreous cavity during ocular movements, not heterogenous echogenic layers in the posterior chamber that tumble with ocular movements. 1
Ultrasound Characteristics of Vitreous Hemorrhage
Vitreous hemorrhage appears on B-scan ultrasound as:
- Low to medium reflective mobile echoes (dot-like particles)
- Diffuse opacities that swirl with eye movement
- Variable density depending on the amount of hemorrhage
- No layering or membrane-like appearance in the posterior chamber
The description in the question incorrectly attributes characteristics of other ocular pathologies to vitreous hemorrhage.
Differentiating Vitreous Hemorrhage from Other Conditions
Vitreous Hemorrhage vs. Posterior Vitreous Detachment (PVD)
- Vitreous Hemorrhage: Mobile dot-like echoes that swirl freely
- PVD: Appears as a thin, highly reflective membrane that moves with eye movements, often with a Weiss ring visible 2
Vitreous Hemorrhage vs. Retinal Detachment
- Vitreous Hemorrhage: Diffuse echoes within the vitreous cavity
- Retinal Detachment: Appears as a highly reflective, continuous membrane attached at the optic disc and ora serrata that doesn't change with eye movements 3
Clinical Significance
B-scan ultrasonography is essential when media opacity prevents adequate examination of the peripheral retina in patients with suspected vitreous hemorrhage 2. The American Academy of Ophthalmology recommends B-scan ultrasound to search for retinal tears, retinal detachment, mass lesions, or other causes of vitreous hemorrhage when direct visualization is not possible 1.
Diagnostic Accuracy
There is considerable variation in the reported sensitivity (44%-100%) of B-scan ultrasonography for detecting retinal tears in cases of posterior vitreous detachment-associated fundus-obscuring vitreous hemorrhage 2. This highlights the importance of understanding the correct ultrasound appearance of vitreous hemorrhage and related pathologies.
Common Pitfalls
- Mistaking posterior vitreous detachment for retinal detachment (a common error) 3
- Confusing vitreous hemorrhage with other echogenic material in the vitreous
- Missing retinal tears, which are accurately diagnosed and localized in only about 44% of cases with ultrasound 4
- Falsely diagnosing retinal detachment (reported false-positive rate of approximately 18.9%) 4
Understanding the correct ultrasound appearance of vitreous hemorrhage is critical for emergency physicians and ophthalmologists to make accurate diagnoses and guide appropriate management decisions.