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.
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
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
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
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
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
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
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
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
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
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
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
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
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
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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