Ultrasound of the Week #002

2 ocular ultrasound cases this week, kindly submitted by Dr Ahmed Abdul-Ghani, ED SpR

Case #1:

A 28 year old male was transferred from another hospital with an atraumatic SAH, GCS 14. CT head was reported as ‘moderate to severe SAH with signs of raised ICP and midline shift’.

An ocular Ultrasound was performed – see below:

Question: What does this demonstrate?

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This ocular ultrasound image very nicely demonstrates a 6.6mm optic nerve consistent with raised ICP (>6mm). The patient was started on Nimodipine and Neurosurgery took over his care. He was otherwise clinically stable.

Further Reading: https://emcrit.org/pulmcrit/pulmcrit-algorithm-diagnosing-icp-elevation-ocular-sonography/


Case #2:

A 75 year old male was transferred from a local District General Hospital‚Äč (DGH) after a fall with left orbital wall fractures. At initial assessment at the DGH he had had proptosis and reduced visual acuity in the affected eye and had had a lateral canthotomy after CT demonstrated retrobulbar haematoma. He was transferred to the MTC for MaxFax and Opthalmology input.

Question: What is indicated by the arrow?

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This ocular ultrasound of his left eye shows a thin hypoechoic zone posterior to the globe in keeping with a retrobulbar haematoma. This is likely significantly reduced from what it would have been pre-procedure.

With this history and symptoms, ocular ultrasound can expedite the diagnosis of retrobulbar haematoma and hence a potentially sight-saving operation.

Further Reading: http://www.nyuemsono.com/wp-content/uploads/2012/10/Early-Detection-of-Traumatic-Retrobulbar-Hemorrhage-Using-Bedside-Ocular-Ultrasound.pdf


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