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.
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
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
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
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
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
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
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
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
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
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
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
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
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.
×
![Ultrasound enlarged image]()
No comments:
Post a Comment