Diagnostic Sonography • B-Scan Eye Pathology Atlas

Posterior Vitreous Detachment (PVD)

A structured ocular ultrasound case collection covering the major sonographic appearances of posterior vitreous detachment, including partial, complete, acute, chronic, symptomatic, Weiss ring, hemorrhage-associated, tractional, retinal tear-associated and complex PVD.

OCULAR ULTRASOUND B-SCAN VITREOUS 12 CASES

Posterior Vitreous Detachment — Case Index

01 Partial PVD →

02 Complete PVD →

03 Acute PVD →

04 Chronic PVD →

05 Symptomatic PVD →

06 PVD with Weiss Ring →

07 PVD with Vitreous Hemorrhage →

08 PVD with Retinal Tear →

09 PVD with Retinal Detachment →

10 Tractional / Incomplete PVD →

11 Ring-shaped / Circumferential PVD →

12 Complex / Membranous PVD →

Chapter 01 • Case Study

Partial Posterior Vitreous Detachment

01 Clinical History

Patient presents with recent visual disturbance or floaters. B-scan demonstrates separation of the posterior hyaloid from the retinal surface over part of the posterior globe, with residual areas of attachment.

02 Ultrasound Image

Figure 1. B-scan demonstrating partial separation of the posterior vitreous hyaloid.

03 Ultrasound Morphology

Feature	Sonographic Description
Posterior hyaloid	Thin linear echogenic membrane separated from the retinal surface over part of the posterior globe.
Attachment	Persistent focal attachment may remain at the optic disc, macula or peripheral vitreoretinal interface.
Mobility	Detached hyaloid may demonstrate characteristic movement with dynamic ocular examination.
Retina	Retinal contour should be separately identified and assessed for retinal detachment.
Vitreous	Associated vitreous opacities or hemorrhagic echoes may be present depending on the clinical setting.

04 Ultrasound Report

A thin mobile echogenic posterior hyaloid membrane is seen partially separated from the retinal surface.

Focal residual attachment is identified.

The retinal contour is maintained without definite detachment on the provided examination.

05 Impression

Sonographic Impression Partial posterior vitreous detachment.

06 Recommendation

Correlate with ophthalmic examination. Carefully evaluate the entire retina and vitreoretinal interface dynamically for retinal tear or detachment.

07 Learning Points

Identify separation of the posterior hyaloid.

Look for persistent focal vitreoretinal attachment.

Use dynamic scanning to assess membrane mobility.

Exclude associated retinal tear or detachment.

Chapter 02 • Case Study

Complete Posterior Vitreous Detachment

01 Clinical History

B-scan demonstrates complete separation of the posterior hyaloid from the retinal surface. The detached posterior hyaloid appears as a mobile membrane within the vitreous cavity.

02 Ultrasound Image

Figure 1. Complete posterior vitreous detachment with mobile posterior hyaloid.

03 Ultrasound Morphology

Feature	Sonographic Description
Hyaloid membrane	Thin echogenic membrane separated from the retinal surface.
Extent	Separation extends broadly around the posterior vitreous cavity.
Mobility	Detached membrane demonstrates mobility with ocular movement.
Retinal relationship	The detached hyaloid should remain distinguishable from the retinal surface.
Associated findings	Evaluate for vitreous hemorrhage, retinal tear and retinal detachment.

04 Ultrasound Report

A thin mobile echogenic membrane is seen completely separated from the posterior retinal surface.

The membrane demonstrates movement on dynamic examination.

The retinal contour is maintained without definite retinal detachment.

05 Impression

Sonographic Impression Complete posterior vitreous detachment.

06 Recommendation

Ophthalmic correlation is recommended. Carefully inspect the peripheral retina for an associated retinal tear, particularly in symptomatic cases.

07 Learning Points

Recognize the detached posterior hyaloid.

Confirm mobility dynamically.

Distinguish PVD from retinal detachment.

Search for associated vitreous hemorrhage or tear.

Chapter 03 • Case Study

Acute Posterior Vitreous Detachment

01 Clinical History

Patient presents with sudden onset of floaters, flashes or visual disturbance. B-scan demonstrates a newly detached mobile posterior hyaloid.

02 Ultrasound Image

Figure 1. Acute PVD with mobile posterior hyaloid.

03 Ultrasound Morphology

Feature	Sonographic Description
Hyaloid	Newly detached thin echogenic posterior hyaloid.
Mobility	Often clearly mobile on dynamic scanning.
Vitreous	May contain low-level vitreous echoes or hemorrhage.
Retina	Careful peripheral retinal examination is required when symptoms suggest a retinal break.

04 Ultrasound Report

Mobile posterior hyaloid membrane is visualized separated from the retinal surface.

Mild vitreous particulate echoes may be present.

No definite retinal detachment is identified on the examined views.

05 Impression

Sonographic Impression Sonographic features of acute posterior vitreous detachment.

06 Recommendation

Prompt ophthalmic examination is appropriate in symptomatic acute PVD to evaluate for retinal tear or other peripheral retinal pathology.

07 Learning Points

Acute PVD may present with sudden floaters or flashes.

Dynamic scanning demonstrates membrane mobility.

Look carefully for associated vitreous hemorrhage.

Exclude retinal tear and detachment clinically.

Chapter 04 • Case Study

Chronic Posterior Vitreous Detachment

01 Clinical History

Patient with longstanding floaters or previous posterior vitreous separation. B-scan demonstrates a mobile detached posterior hyaloid with relatively stable configuration.

02 Ultrasound Image

Figure 1. Chronic PVD with separated posterior vitreous hyaloid.

03 Ultrasound Morphology

Feature	Sonographic Description
Membrane	Thin detached posterior hyaloid within the vitreous cavity.
Mobility	Mobile with ocular movement, often with a relatively established configuration.
Vitreous	May show vitreous syneresis or low-level echoes.
Retina	Retinal contour should remain separately visualized.

04 Ultrasound Report

Thin mobile posterior hyaloid membrane is separated from the retinal surface.

Findings are compatible with established posterior vitreous detachment.

No definite retinal detachment is demonstrated.

05 Impression

Sonographic Impression Chronic / established posterior vitreous detachment.

06 Recommendation

Correlate with the ophthalmic examination and clinical history. Evaluate the retina when visualization is clinically indicated.

07 Learning Points

Identify the established detached hyaloid.

Assess membrane mobility.

Distinguish chronic PVD from retinal detachment.

Assess for associated vitreous degeneration.

Chapter 05 • Case Study

Symptomatic Posterior Vitreous Detachment

01 Clinical History

Patient presents with new-onset floaters, flashes or visual symptoms. B-scan demonstrates a detached posterior hyaloid requiring careful evaluation for associated retinal pathology.

02 Ultrasound Image

Figure 1. Mobile posterior hyaloid in symptomatic PVD.

03 Ultrasound Morphology

Feature	Sonographic Description
Hyaloid	Mobile detached posterior vitreous membrane.
Vitreous echoes	May be absent or may accompany vitreous syneresis or hemorrhage.
Peripheral retina	Must be assessed carefully for associated retinal break or detachment.
Dynamic assessment	Use multiple meridional planes and ocular movement to assess the posterior hyaloid and retina.

04 Ultrasound Report

Mobile echogenic posterior hyaloid membrane is identified within the vitreous cavity.

Dynamic examination demonstrates vitreous membrane mobility.

No definite retinal detachment is identified within the examined field.

05 Impression

Sonographic Impression Posterior vitreous detachment in a symptomatic clinical setting.

06 Recommendation

Ophthalmic assessment is recommended, particularly when symptoms are acute, to exclude retinal tear or retinal detachment.

07 Learning Points

Correlate the ultrasound appearance with symptoms.

Examine the posterior hyaloid dynamically.

Search systematically for retinal pathology.

Do not equate a detached hyaloid with retinal detachment.

Chapter 06 • Case Study

PVD with Weiss Ring

01 Clinical History

Patient presents with new floaters. Ultrasound demonstrates a detached posterior hyaloid and a focal ring-like echogenic structure in the vitreous cavity corresponding to a clinically suspected Weiss ring.

02 Ultrasound Image

Figure 1. Ring-like echogenic structure associated with posterior vitreous detachment.

03 Ultrasound Morphology

Feature	Sonographic Description
Posterior hyaloid	Detached mobile posterior hyaloid membrane.
Ring structure	Focal circular or incomplete ring-like echogenic structure may be visible within the vitreous.
Mobility	The ring-like structure may move independently within the vitreous cavity.
Retina	Peripheral retinal evaluation remains important.

04 Ultrasound Report

Mobile posterior vitreous hyaloid membrane is separated from the retinal surface.

A focal ring-like echogenic structure is visualized within the vitreous cavity.

No definite retinal detachment is identified.

05 Impression

Sonographic Impression Posterior vitreous detachment with ring-like vitreous opacity, compatible with a Weiss ring in the appropriate clinical setting.

06 Recommendation

Correlate with dilated fundus examination and evaluate carefully for an associated retinal tear.

07 Learning Points

Recognize a focal ring-like vitreous opacity.

Assess mobility dynamically.

Confirm associated posterior hyaloid separation.

Exclude peripheral retinal tear.

Chapter 07 • Case Study

PVD with Vitreous Hemorrhage

01 Clinical History

Patient presents with sudden visual obscuration and vitreous floaters. B-scan demonstrates a detached posterior hyaloid with associated mobile vitreous hemorrhagic echoes.

02 Ultrasound Image

Figure 1. Posterior vitreous detachment with associated vitreous hemorrhagic echoes.

03 Ultrasound Morphology

Feature	Sonographic Description
PVD	Mobile posterior hyaloid membrane separated from the retinal surface.
Hemorrhage	Fine, diffuse or coarse mobile vitreous echoes may be present.
Mobility	Both the detached hyaloid and hemorrhagic echoes should be assessed dynamically.
Retina	Carefully evaluate for retinal tear and retinal detachment.

04 Ultrasound Report

Mobile posterior hyaloid membrane is detached from the retinal surface.

Multiple mobile low-to-medium level vitreous echoes are present, compatible with vitreous hemorrhagic debris.

No definite retinal detachment is identified on the examined views.

05 Impression

Sonographic Impression Posterior vitreous detachment with associated vitreous hemorrhage.

06 Recommendation

Urgent ophthalmic correlation is recommended, with careful evaluation for retinal tear or retinal detachment when clinically appropriate.

07 Learning Points

Identify both the detached hyaloid and hemorrhage.

Use dynamic scanning to assess mobility.

Search carefully for retinal tear.

Exclude retinal detachment.

Chapter 08 • Case Study

PVD with Suspected Retinal Tear

01 Clinical History

Patient with acute symptomatic PVD and new flashes or floaters. B-scan demonstrates a detached posterior hyaloid with focal abnormality along the retinal contour requiring clinical correlation.

02 Ultrasound Image

Figure 1. PVD with focal retinal abnormality requiring assessment for retinal tear.

03 Ultrasound Morphology

Feature	Sonographic Description
PVD	Detached mobile posterior hyaloid.
Retinal contour	Focal irregularity may raise suspicion for associated retinal pathology.
Vitreous	Hemorrhagic echoes may accompany a retinal break.
Dynamic study	Multiple scanning planes should be used to examine the peripheral retina.

04 Ultrasound Report

Posterior vitreous hyaloid is detached and mobile.

Focal retinal contour abnormality is noted and should be correlated with ophthalmic examination for a possible retinal tear.

No definite extensive retinal detachment is identified.

05 Impression

Sonographic Impression Posterior vitreous detachment with focal retinal abnormality suspicious for associated retinal tear; ophthalmic correlation required.

06 Recommendation

Prompt ophthalmic examination is recommended to assess the peripheral retina and confirm or exclude retinal tear.

07 Learning Points

Acute PVD can coexist with retinal breaks.

Carefully examine peripheral retinal contours.

Vitreous hemorrhage increases concern for associated retinal pathology.

Clinical examination remains essential.

Chapter 09 • Case Study

PVD with Retinal Detachment

01 Clinical History

Patient presents with significant visual disturbance. B-scan demonstrates a detached posterior hyaloid together with a separate highly reflective retinal membrane consistent with retinal detachment.

02 Ultrasound Image

Figure 1. Posterior vitreous detachment associated with retinal detachment.

03 Ultrasound Morphology

Feature	Sonographic Description
PVD membrane	Thin mobile posterior hyaloid separated from the retinal surface.
Retinal detachment	Separate thicker echogenic membrane arising from the optic disc region and extending toward the peripheral retina.
Mobility	Retinal detachment and posterior hyaloid may show different movement patterns.
Configuration	Assess extent, attachment and configuration of the retinal detachment in multiple planes.

04 Ultrasound Report

Mobile posterior vitreous hyaloid is detached from the retinal surface.

A separate elevated echogenic retinal membrane is identified, compatible with retinal detachment.

The extent and configuration of retinal elevation should be correlated with the clinical examination.

05 Impression

Sonographic Impression Posterior vitreous detachment associated with retinal detachment.

06 Recommendation

Urgent ophthalmic evaluation is recommended. Document the extent and configuration of retinal detachment when possible.

07 Learning Points

Identify the detached posterior hyaloid separately.

Recognize the thicker retinal detachment membrane.

Assess membrane mobility and attachment.

Document retinal detachment extent.

Chapter 10 • Case Study

Tractional / Incomplete Posterior Vitreous Detachment

01 Clinical History

B-scan demonstrates incomplete separation of the posterior hyaloid with persistent focal vitreoretinal attachment and localized traction.

02 Ultrasound Image

Figure 1. Incomplete PVD with focal vitreoretinal attachment and traction.

03 Ultrasound Morphology

Feature	Sonographic Description
Hyaloid	Partially detached posterior vitreous membrane.
Attachment	Persistent focal attachment to the retinal surface.
Traction	Focal tenting, distortion or localized elevation may be demonstrated.
Dynamic appearance	Mobile detached portions contrast with relatively fixed attached areas.

04 Ultrasound Report

Posterior vitreous hyaloid is partially detached with persistent focal vitreoretinal attachment.

Localized tractional configuration is noted at the site of persistent attachment.

No definite extensive retinal detachment is identified on the examined views.

05 Impression

Sonographic Impression Incomplete posterior vitreous detachment with focal vitreoretinal traction.

06 Recommendation

Ophthalmic correlation is recommended to assess the macula, vitreoretinal interface and retinal contour.

07 Learning Points

Recognize incomplete hyaloid separation.

Identify focal persistent attachment.

Look for tractional distortion.

Carefully assess the retinal contour.

Chapter 11 • Case Study

Ring-shaped / Circumferential PVD

01 Clinical History

B-scan demonstrates a circumferential or ring-like posterior vitreous membrane within the vitreous cavity, compatible with a characteristic configuration of posterior vitreous separation.

02 Ultrasound Image

Figure 1. Circumferential/ring-like posterior vitreous membrane.

03 Ultrasound Morphology

Feature	Sonographic Description
Configuration	Ring-shaped or circumferential echogenic vitreous membrane.
Mobility	May move within the vitreous cavity with ocular movement.
Relationship	The membrane should be distinguished from retinal detachment.
Associated findings	Evaluate for vitreous hemorrhage, retinal tear and tractional changes.

04 Ultrasound Report

A ring-shaped/circumferential echogenic membrane is identified within the vitreous cavity.

The membrane demonstrates mobility with dynamic examination.

The retinal contour remains separately visualized.

05 Impression

Sonographic Impression Ring-shaped / circumferential posterior vitreous detachment.

06 Recommendation

Correlate with ophthalmic examination and evaluate the peripheral retina for associated retinal pathology.

07 Learning Points

Recognize ring-like vitreous membrane configuration.

Confirm membrane mobility.

Distinguish the membrane from retinal detachment.

Search for associated vitreoretinal pathology.

Chapter 12 • Case Study

Complex / Membranous Posterior Vitreous Detachment

01 Clinical History

Patient with vitreous degeneration or previous ocular pathology. B-scan demonstrates a complex mobile vitreous membrane with internal strands, folds or multiple membranous components.

02 Ultrasound Image

Figure 1. Complex membranous posterior vitreous detachment with internal vitreous strands.

03 Ultrasound Morphology

Feature	Sonographic Description
Membrane	Complex echogenic posterior vitreous membrane with folds, strands or multiple components.
Mobility	Variable mobility depending on the degree of vitreous organization.
Internal structure	Internal fibrillar or membranous echoes may be present.
Retinal relationship	Carefully distinguish complex vitreous membranes from retinal detachment.
Associated pathology	Assess for vitreous hemorrhage, traction, proliferative membranes and retinal detachment.

04 Ultrasound Report

Complex mobile echogenic vitreous membrane is identified within the posterior vitreous cavity.

Internal folds/strands are present with variable mobility on dynamic examination.

The retinal contour has been evaluated separately for retinal detachment.

05 Impression

Sonographic Impression Complex / membranous posterior vitreous detachment.

06 Recommendation

Correlate with ophthalmic examination. Careful dynamic B-scan assessment is recommended to distinguish complex vitreous membranes from retinal detachment or tractional pathology.

07 Learning Points

Recognize complex vitreous membrane patterns.

Assess mobility and internal organization.

Distinguish vitreous membranes from retinal detachment.

Search for traction and associated pathology.

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Vitreous Hemorrhage/Hematoma

Diagnostic Sonography • B-Scan Eye Pathology Atlas

Vitreous Hemorrhage or Hematoma

A structured ocular ultrasound case collection covering the major sonographic morphological patterns of vitreous hemorrhage, including particulate, diffuse, dense, clotted, layered, loculated, organized, membranous, retrohyaloid, PVD-associated, tractional, retinal detachment-associated and postoperative/recurrent hemorrhage.

OCULAR ULTRASOUND B-SCAN VITREOUS 13 CASES

Vitreous Hemorrhage — Case Index

01 Fine Particulate →

02 Diffuse →

03 Dense / Coarse →

04 Clotted →

05 Layered / Dependent →

06 Loculated →

07 Fibrinous / Organized →

08 Membranous →

09 Retrohyaloid / Subhyaloid →

10 Associated PVD →

11 Associated Tractional Membrane →

12 Associated Retinal Detachment →

13 Post-vitrectomy / Recurrent VH →

Chapter 01 • Case Study

Fine Particulate Vitreous Hemorrhage

01 Clinical History

Patient presents with sudden or progressive visual disturbance. Ocular B-scan demonstrates fine low-level particulate echoes within the vitreous cavity.

02 Ultrasound Image

Figure 1. B-scan demonstrating fine particulate vitreous echoes.

03 Ultrasound Morphology

Feature	Sonographic Description
Echo pattern	Numerous fine, low-level particulate echoes distributed within the vitreous cavity.
Distribution	May be diffuse or more concentrated within portions of the vitreous.
Mobility	Fine echoes may demonstrate marked movement or swirling following ocular movement.
Retina	Assess carefully for an associated retinal detachment.
Posterior hyaloid	Assess for associated posterior vitreous detachment.
Additional assessment	Examine the entire vitreous cavity dynamically in multiple meridional planes.

04 Ultrasound Report

Fine low-level particulate echoes are seen within the vitreous cavity, compatible with vitreous hemorrhagic debris.

Dynamic examination demonstrates mobility of the vitreous echoes.

The posterior hyaloid and retina should be assessed for associated PVD or retinal detachment.

05 Impression

Sonographic Impression Fine particulate vitreous hemorrhage.

06 Recommendation

Correlate with ophthalmic examination. Perform careful dynamic B-scan assessment of the posterior hyaloid, retina and optic disc region when the fundus is not adequately visualized.

07 Learning Points

Recognize fine particulate vitreous echoes.

Assess mobility dynamically.

Examine the posterior hyaloid for PVD.

Carefully exclude associated retinal detachment.

Chapter 02 • Case Study

Diffuse Vitreous Hemorrhage

01 Clinical History

Patient presents with reduced or obscured vision. B-scan demonstrates hemorrhagic echoes distributed throughout a substantial portion of the vitreous cavity.

02 Ultrasound Image

Figure 1. B-scan appearance of diffuse vitreous hemorrhage.

03 Ultrasound Morphology

Feature	Sonographic Description
Distribution	Hemorrhagic echoes distributed through a large portion or most of the vitreous cavity.
Echo intensity	Variable from low-level particulate echoes to more conspicuous heterogeneous echoes.
Mobility	May demonstrate movement with ocular motion.
Membranes	Assess for posterior hyaloid or organized membranes.
Retina	Examine for retinal detachment or focal traction.

04 Ultrasound Report

Diffuse vitreous echoes are present throughout the vitreous cavity, compatible with diffuse vitreous hemorrhage.

Dynamic assessment demonstrates variable mobility of the hemorrhagic echoes.

No definite retinal detachment is identified on the provided examination, if applicable.

05 Impression

Sonographic Impression Diffuse vitreous hemorrhage.

06 Recommendation

Correlate with clinical and ophthalmic findings. Dynamic evaluation of the retina and posterior hyaloid is recommended.

07 Learning Points

Identify the overall distribution of hemorrhagic echoes.

Assess mobility using dynamic scanning.

Search systematically for associated membranes.

Exclude retinal detachment.

Chapter 03 • Case Study

Dense / Coarse Vitreous Hemorrhage

01 Clinical History

Patient presents with marked visual obscuration. B-scan demonstrates numerous medium-to-high amplitude coarse echoes within the vitreous cavity.

02 Ultrasound Image

Figure 1. Dense/coarse vitreous hemorrhagic echoes.

03 Ultrasound Morphology

Feature	Sonographic Description
Echo pattern	Medium-to-high amplitude coarse and heterogeneous echoes within the vitreous.
Distribution	Focal, multifocal or diffuse depending on the extent of hemorrhage.
Mobility	May be less freely mobile than fine particulate hemorrhagic echoes.
Organization	Assess for clot formation, fibrin strands and membrane development.
Associated pathology	Assess for PVD, tractional membranes and retinal detachment.

04 Ultrasound Report

Dense heterogeneous coarse echogenic material is present within the vitreous cavity, consistent with dense vitreous hemorrhage.

The hemorrhagic echoes demonstrate reduced/ variable mobility on dynamic examination.

The posterior hyaloid and retina have been assessed for associated pathology.

05 Impression

Sonographic Impression Dense / coarse vitreous hemorrhage.

06 Recommendation

Correlate with ophthalmic examination and evaluate the posterior hyaloid and retina dynamically.

07 Learning Points

Recognize coarse and dense hemorrhagic echoes.

Compare mobility with finer particulate hemorrhage.

Look for early organization or clot formation.

Evaluate the retina throughout the examination.

Chapter 04 • Case Study

Clotted Vitreous Hemorrhage

01 Clinical History

Patient with vitreous hemorrhage demonstrates compact, irregular echogenic aggregates representing relatively consolidated hemorrhagic material.

02 Ultrasound Image

Figure 1. Compact clotted hemorrhagic echoes within the vitreous cavity.

03 Ultrasound Morphology

Feature	Sonographic Description
Configuration	Compact irregular or mass-like echogenic aggregates within the vitreous.
Mobility	Reduced compared with freely suspended fine particulate hemorrhage.
Internal pattern	Heterogeneous echogenicity may be present.
Organization	Assess for fibrinous strands, septations or developing membranes.
Retina	Carefully evaluate for associated retinal detachment.

04 Ultrasound Report

Irregular compact echogenic aggregates are identified within the vitreous cavity, compatible with clotted vitreous hemorrhage.

Mobility is reduced compared with fine particulate vitreous echoes.

No definite retinal detachment is identified if adequately assessed.

05 Impression

Sonographic Impression Clotted vitreous hemorrhage.

06 Recommendation

Ophthalmic correlation is recommended. Continue dynamic assessment for associated PVD, organization, tractional membranes or retinal detachment.

07 Learning Points

Identify compact hemorrhagic aggregates.

Assess mobility dynamically.

Look for organization and fibrin.

Exclude retinal detachment.

Chapter 05 • Case Study

Layered / Dependent Vitreous Hemorrhage

01 Clinical History

B-scan demonstrates accumulation of hemorrhagic echoes in the dependent portion of the vitreous cavity, producing a layered or sedimented appearance.

02 Ultrasound Image

Figure 1. Dependent layering of vitreous hemorrhagic echoes.

03 Ultrasound Morphology

Feature	Sonographic Description
Distribution	Predominantly dependent accumulation of hemorrhagic material.
Interface	May demonstrate a relatively defined interface between more echogenic sediment and clearer vitreous.
Mobility	Dependent material may shift or redistribute with prolonged positional change.
Associated findings	Evaluate for PVD, organized membranes and retinal detachment.

04 Ultrasound Report

Hemorrhagic echoes demonstrate dependent layering within the vitreous cavity.

The dependent component demonstrates variable mobility on dynamic assessment.

The posterior hyaloid and retinal contour have been evaluated for associated pathology.

05 Impression

Sonographic Impression Layered / dependent vitreous hemorrhage.

06 Recommendation

Correlate with ophthalmic examination and perform dynamic assessment of the vitreous and retina.

07 Learning Points

Recognize dependent sedimentation of hemorrhagic echoes.

Assess the fluid-debris relationship.

Observe positional mobility where appropriate.

Evaluate the retina and posterior hyaloid.

Chapter 06 • Case Study

Loculated Vitreous Hemorrhage

01 Clinical History

Ultrasound demonstrates focal or compartmentalized hemorrhagic collections within the vitreous cavity, with limited free movement.

02 Ultrasound Image

Figure 1. Loculated vitreous hemorrhagic collection.

03 Ultrasound Morphology

Feature	Sonographic Description
Configuration	Focal or compartmentalized echogenic hemorrhagic collection.
Margins	May be defined by internal vitreous septa or membranes.
Mobility	Limited movement within the affected compartment.
Internal structure	May contain heterogeneous echoes, clots or fibrin.
Associated pathology	Assess for organized vitreous membranes, traction and retinal detachment.

04 Ultrasound Report

Focal compartmentalized echogenic hemorrhagic material is seen within the vitreous cavity, consistent with loculated vitreous hemorrhage.

The collection demonstrates limited mobility.

Internal membranes and the retinal contour have been assessed for associated pathology.

05 Impression

Sonographic Impression Loculated vitreous hemorrhage.

06 Recommendation

Ophthalmic correlation and careful dynamic B-scan evaluation are recommended.

07 Learning Points

Identify compartmentalized hemorrhage.

Assess internal septations and membranes.

Determine the degree of mobility.

Search for traction and retinal detachment.

Chapter 07 • Case Study

Fibrinous / Organized Vitreous Hemorrhage

01 Clinical History

Persistent vitreous hemorrhage is demonstrated with increasingly organized echogenic material, fibrinous strands and internal septations.

02 Ultrasound Image

Figure 1. Fibrinous/organized vitreous hemorrhage.

03 Ultrasound Morphology

Feature	Sonographic Description
Echo pattern	Heterogeneous echogenic material with fibrinous strands and internal septations.
Organization	Partial or advanced organization of previously hemorrhagic material.
Mobility	Generally reduced compared with fresh particulate hemorrhage.
Membranes	Fibrinous sheets or strands may be seen.
Traction	Evaluate for tractional membranes and retinal elevation.

04 Ultrasound Report

Heterogeneous organized echogenic material with internal fibrinous strands is identified within the vitreous cavity.

The hemorrhagic material demonstrates reduced mobility, compatible with organized vitreous hemorrhage.

Assess for associated tractional membranes and retinal detachment.

05 Impression

Sonographic Impression Fibrinous / organized vitreous hemorrhage.

06 Recommendation

Ophthalmic evaluation is recommended, particularly when organized membranes or traction are suspected.

07 Learning Points

Recognize fibrinous organization.

Assess membrane thickness and mobility.

Look for tractional effects.

Exclude associated retinal detachment.

Chapter 08 • Case Study

Membranous Vitreous Hemorrhage

01 Clinical History

B-scan demonstrates linear, sheet-like or branching echogenic structures within the vitreous cavity in association with vitreous hemorrhage.

02 Ultrasound Image

Figure 1. Membranous echogenic structures associated with vitreous hemorrhage.

03 Ultrasound Morphology

Feature	Sonographic Description
Configuration	Thin or thick linear, sheet-like or branching echogenic structures.
Mobility	Variable according to membrane attachment and organization.
Internal echoes	Hemorrhagic echoes may be distributed around or within the membrane.
Attachment	Determine whether the membrane is free, posterior hyaloid-related or retinally attached.
Retina	Evaluate carefully for retinal detachment.

04 Ultrasound Report

Linear and sheet-like echogenic membranous structures are identified within the vitreous cavity in association with vitreous hemorrhagic echoes.

Dynamic examination demonstrates variable membrane mobility.

The retinal contour has been assessed for associated detachment.

05 Impression

Sonographic Impression Membranous vitreous hemorrhage.

06 Recommendation

Correlate with ophthalmic examination. Characterize membrane attachment and evaluate for retinal traction or detachment.

07 Learning Points

Recognize linear and sheet-like vitreous membranes.

Assess membrane mobility.

Determine membrane attachment.

Exclude retinal detachment.

Chapter 09 • Case Study

Retrohyaloid / Subhyaloid Hemorrhage

01 Clinical History

B-scan demonstrates localized hemorrhagic material immediately posterior to the detached or elevated posterior hyaloid and anterior to the retinal surface.

02 Ultrasound Image

Figure 1. Retrohyaloid/subhyaloid hemorrhagic collection.

03 Ultrasound Morphology

Feature	Sonographic Description
Location	Hemorrhagic material located between the posterior hyaloid and retinal surface.
Configuration	May appear crescentic, triangular, dome-like or localized depending on distribution.
Posterior hyaloid	Identify and characterize the posterior hyaloid membrane.
Mobility	Variable depending on the degree of organization and attachment.
Retina	Carefully differentiate the collection from retinal detachment.

04 Ultrasound Report

Localized echogenic hemorrhagic material is seen immediately posterior to the posterior hyaloid, compatible with retrohyaloid/subhyaloid hemorrhage.

The posterior hyaloid is separately assessed for detachment and mobility.

Retinal contour is evaluated to exclude associated retinal detachment.

05 Impression

Sonographic Impression Retrohyaloid / subhyaloid vitreous hemorrhage.

06 Recommendation

Ophthalmic correlation is recommended. Carefully evaluate the retinal contour and posterior hyaloid attachment.

07 Learning Points

Localize hemorrhage relative to the posterior hyaloid.

Identify the posterior hyaloid separately.

Evaluate dynamic mobility.

Differentiate from retinal detachment.

Chapter 10 • Case Study

Vitreous Hemorrhage with Associated PVD

01 Clinical History

B-scan demonstrates vitreous hemorrhagic echoes associated with a mobile detached posterior hyaloid membrane.

02 Ultrasound Image

Figure 1. Vitreous hemorrhage with associated posterior vitreous detachment.

03 Ultrasound Morphology

Feature	Sonographic Description
Vitreous hemorrhage	Variable particulate or heterogeneous hemorrhagic echoes within the vitreous.
Posterior hyaloid	Mobile echogenic posterior hyaloid membrane separated from the retinal surface.
Mobility	Posterior hyaloid may demonstrate prominent undulating movement during dynamic scanning.
Optic disc relationship	Assess the posterior hyaloid relationship to the optic disc.
Retina	Carefully exclude associated retinal detachment.

04 Ultrasound Report

Vitreous hemorrhagic echoes are present within the vitreous cavity.

A mobile posterior hyaloid membrane is identified, compatible with posterior vitreous detachment.

No definite retinal detachment is demonstrated, if adequately visualized.

05 Impression

Sonographic Impression Vitreous hemorrhage with associated posterior vitreous detachment.

06 Recommendation

Ophthalmic assessment is recommended. Carefully evaluate the retinal periphery for associated retinal breaks or detachment.

07 Learning Points

Identify the detached posterior hyaloid.

Assess its mobility during dynamic scanning.

Establish its relationship with the optic disc.

Search carefully for retinal detachment.

Chapter 11 • Case Study

Vitreous Hemorrhage with Associated Tractional Membrane

01 Clinical History

Vitreous hemorrhagic echoes are associated with irregular echogenic tractional membranes producing focal retinal elevation or distortion.

02 Ultrasound Image

Figure 1. Vitreous hemorrhage associated with tractional membrane.

03 Ultrasound Morphology

Feature	Sonographic Description
Hemorrhage	Variable hemorrhagic echoes within the vitreous cavity.
Tractional membrane	Irregular, taut or branching echogenic membrane associated with focal retinal elevation.
Mobility	Tractional membranes generally demonstrate less free mobility than a detached posterior hyaloid.
Retinal contour	Assess for focal or broad retinal elevation and traction.
Detachment	Determine whether the appearance represents tractional elevation or an associated retinal detachment.

04 Ultrasound Report

Vitreous hemorrhagic echoes are associated with an irregular echogenic tractional membrane.

The membrane demonstrates limited mobility with focal retinal traction/elevation.

The retinal contour has been evaluated for associated retinal detachment.

05 Impression

Sonographic Impression Vitreous hemorrhage with associated tractional membrane.

06 Recommendation

Prompt ophthalmic correlation is recommended when tractional retinal elevation is demonstrated.

07 Learning Points

Recognize taut tractional membranes.

Assess membrane mobility and attachment.

Identify focal retinal traction.

Distinguish tractional elevation from retinal detachment.

Chapter 12 • Case Study

Vitreous Hemorrhage with Associated Retinal Detachment

01 Clinical History

B-scan demonstrates vitreous hemorrhage together with a detached retinal membrane. Dynamic scanning is used to characterize the detached retina and its attachment.

02 Ultrasound Image

Figure 1. Vitreous hemorrhage associated with retinal detachment.

03 Ultrasound Morphology

Feature	Sonographic Description
Vitreous hemorrhage	Variable particulate, coarse or heterogeneous vitreous echoes.
Retinal membrane	More structured echogenic membrane forming the detached retinal contour.
Configuration	Detached retina may demonstrate characteristic folded, tented or funnel-shaped configurations depending on extent.
Optic disc relationship	Assess retinal attachment toward the optic disc.
Mobility	Detached retina may demonstrate movement but generally differs from the highly mobile posterior hyaloid.

04 Ultrasound Report

Vitreous hemorrhagic echoes are present within the vitreous cavity.

A detached echogenic retinal membrane is identified, with configuration and extent documented on dynamic B-scan examination.

The retinal membrane is followed toward the optic disc to establish its attachment.

05 Impression

Sonographic Impression Vitreous hemorrhage with associated retinal detachment.

06 Recommendation

Urgent ophthalmic correlation is recommended when retinal detachment is identified or strongly suspected.

07 Learning Points

Identify the retinal membrane separately from the posterior hyaloid.

Assess retinal configuration and extent.

Establish the relationship to the optic disc.

Document associated vitreous hemorrhage.

Chapter 13 • Case Study

Post-vitrectomy / Recurrent Vitreous Hemorrhage

01 Clinical History

Patient with previous vitreoretinal surgery presents with recurrent visual symptoms. B-scan demonstrates variable echogenic material within a surgically altered vitreous cavity.

02 Ultrasound Image

Figure 1. Post-vitrectomy/recurrent vitreous hemorrhage.

03 Ultrasound Morphology

Feature	Sonographic Description
Vitreous cavity	Surgically altered vitreous cavity with variable internal echogenic material.
Hemorrhage	May range from fine particulate echoes to dense clotted or organized hemorrhagic material.
Membranes	Residual or postoperative membranes may be present.
Mobility	Depends on residual vitreous, clot organization and postoperative membrane attachment.
Retina	Carefully evaluate for recurrent or residual retinal detachment.
Postoperative changes	Interpret the findings in relation to the history and type of previous vitreoretinal surgery.

04 Ultrasound Report

Postoperative vitreous cavity demonstrates variable echogenic material compatible with recurrent vitreous hemorrhagic change.

The echogenic material demonstrates variable mobility according to its degree of organization.

Postoperative membranes and retinal contour have been assessed for recurrent or residual detachment.

05 Impression

Sonographic Impression Post-vitrectomy / recurrent vitreous hemorrhage.

06 Recommendation

Correlate with the surgical history and ophthalmic examination. Dynamic B-scan assessment should include the postoperative membranes and retinal contour.

07 Learning Points

Always interpret the vitreous cavity in relation to previous surgery.

Recurrent hemorrhage may have variable echogenicity.

Assess postoperative membranes dynamically.

Carefully evaluate for recurrent retinal detachment.

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