Diagnostic Sonography • B-Scan Eye Pathology Atlas
Vitritis
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.
Vitritis — Case Index
01
Fine Particulate Vitritis
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02
Diffuse Vitritis
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03
Dense / Coarse Vitritis
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04
Clotted Vitritis
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05
Layered / Dependent Vitritis
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06
Membranous Vitritis
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07
Focal / Localized Vitritis
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08
Organized Vitritis
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09
Chronic / Established Vitritis
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10
Severe Vitritis with Marked Opacification
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11
Intermediate / Mixed Vitritis
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12
Complex Vitritis with Membranous / Clumped Debris
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Chapter 01 • Case Study
Fine Particulate Vitritis
01 Clinical History
B-scan demonstrates numerous fine, low-level mobile echoes distributed within the vitreous cavity. The globe is assessed dynamically to distinguish inflammatory vitreous debris from other causes of vitreous opacification.
02 Ultrasound Image
03 Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Vitreous echoes | Numerous fine, low-level echogenic particles are scattered throughout the vitreous cavity. |
| Distribution | Particles may be diffuse or mildly dependent within the vitreous. |
| Mobility | Fine echoes demonstrate movement with dynamic ocular examination. |
| Retina | Retinal contour should be separately assessed for associated detachment or focal pathology. |
| Clinical correlation | Correlate with ocular inflammation, symptoms and examination findings. |
04 Ultrasound Report
Numerous fine low-level mobile echoes are seen throughout the vitreous cavity.
The echoes demonstrate mobility on dynamic examination.
No definite retinal detachment is identified on the examined views.
05 Impression
Sonographic Impression
Sonographic features of fine particulate vitritis.
06 Recommendation
Correlate with ophthalmic examination and the clinical setting. Assess the retina and vitreoretinal interface carefully.
07 Learning Points
Recognize fine low-level vitreous particulate echoes.
Confirm mobility dynamically.
Assess the entire vitreous cavity systematically.
Exclude associated retinal pathology.
Chapter 02 • Case Study
Diffuse Vitritis
01 Clinical History
B-scan demonstrates diffuse vitreous low-to-medium level echoes throughout a substantial portion of the vitreous cavity, consistent with generalized vitreous inflammatory debris in the appropriate clinical setting.
02 Ultrasound Image
03 Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Echoes | Diffuse low-to-medium level echogenic material fills much of the vitreous cavity. |
| Distribution | Opacities are widespread rather than confined to a single focal region. |
| Mobility | Internal echoes generally move with ocular movement. |
| Vitreous clarity | The normal anechoic vitreous appearance is reduced by inflammatory debris. |
| Retina | Evaluate separately for retinal detachment, choroidal abnormality or other associated disease. |
04 Ultrasound Report
Diffuse low-to-medium level mobile vitreous echoes are present.
The vitreous cavity demonstrates generalized particulate echogenicity.
No definite retinal detachment is identified on the examined views.
05 Impression
Sonographic Impression
Diffuse vitreous inflammatory opacification, compatible with vitritis in the appropriate clinical setting.
06 Recommendation
Correlate with slit-lamp/fundus examination and clinical findings. Evaluate the retina and choroid for associated pathology.
07 Learning Points
Assess the extent of vitreous involvement.
Use dynamic scanning to confirm mobility.
Distinguish diffuse vitritis from hemorrhagic debris.
Search for associated posterior segment disease.
Chapter 03 • Case Study
Dense / Coarse Vitritis
01 Clinical History
B-scan demonstrates numerous medium-to-high level coarse vitreous echoes with marked internal debris. Dynamic scanning is used to assess mobility and to evaluate the underlying retina.
02 Ultrasound Image
03 Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Echo intensity | Medium-to-high level coarse echogenic vitreous debris is present. |
| Distribution | Coarse echoes may be diffuse, clustered or unevenly distributed. |
| Mobility | Debris may demonstrate variable but appreciable movement on dynamic examination. |
| Vitreous | Marked vitreous opacification reduces visualization of the posterior segment. |
| Retina | Careful scanning is required to exclude retinal detachment or other associated pathology. |
04 Ultrasound Report
Multiple coarse echogenic vitreous echoes are present.
The echoes demonstrate variable mobility on dynamic examination.
The retinal contour remains separately identifiable without definite detachment on the examined views.
05 Impression
Sonographic Impression
Dense/coarse vitreous inflammatory debris compatible with vitritis in the appropriate clinical setting.
06 Recommendation
Ophthalmic correlation is recommended. Carefully assess the retina and optic disc region when visualization permits.
07 Learning Points
Recognize increased echo density in severe vitreous inflammation.
Assess mobility and distribution.
Do not confuse dense vitreous debris with retinal detachment.
Use multiple scan planes.
Chapter 04 • Case Study
Clotted Vitritis
01 Clinical History
B-scan demonstrates focal-to-multifocal compact echogenic aggregates within the vitreous cavity, producing a clumped or clotted appearance rather than uniformly dispersed particulate echoes.
02 Ultrasound Image
03 Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Clumps | Compact echogenic aggregates are seen within the vitreous cavity. |
| Configuration | The aggregates may appear irregular, rounded or lobulated. |
| Mobility | Clumped material may move as larger aggregates with ocular movement. |
| Background vitreous | Additional fine echoes may coexist around the compact aggregates. |
| Retina | The retinal contour must be separately followed throughout the examination. |
04 Ultrasound Report
Irregular compact echogenic clumps are seen within the vitreous cavity.
The clumped echoes demonstrate mobility with dynamic examination.
No definite retinal detachment is identified on the examined views.
05 Impression
Sonographic Impression
Clumped/clotted vitreous inflammatory debris compatible with vitritis.
06 Recommendation
Correlate with ophthalmic examination and clinical history. Evaluate for associated vitreous hemorrhage, infection or other posterior segment pathology as clinically indicated.
07 Learning Points
Identify compact vitreous aggregates.
Assess their mobility.
Compare clotted material with retinal membranes.
Evaluate for mixed vitreous pathology.
Chapter 05 • Case Study
Layered / Dependent Vitritis
01 Clinical History
B-scan demonstrates echogenic vitreous material accumulating dependently, producing a layering appearance. Dynamic scanning helps assess movement and separation of the dependent material.
02 Ultrasound Image
03 Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Layering | Echogenic material forms a dependent layer within the vitreous cavity. |
| Interface | A relatively distinct interface may be visible between clearer and more echogenic vitreous. |
| Mobility | The dependent material may shift with changes in eye position or movement. |
| Density | Echo density can range from fine particulate to more organized debris. |
| Retina | The retinal contour should be traced separately from the dependent vitreous material. |
04 Ultrasound Report
Dependent echogenic vitreous material demonstrates a layered configuration.
The material shows movement/reorganization on dynamic examination.
The retina is separately visualized without definite detachment on the examined views.
05 Impression
Sonographic Impression
Layered/dependent vitreous inflammatory debris compatible with vitritis.
06 Recommendation
Correlate with clinical and ophthalmic findings. Assess the posterior segment for associated inflammatory or hemorrhagic pathology.
07 Learning Points
Recognize dependent vitreous layering.
Use dynamic examination and positional change when appropriate.
Distinguish vitreous layering from retinal detachment.
Assess the underlying retina.
Chapter 06 • Case Study
Membranous Vitritis
01 Clinical History
B-scan demonstrates echogenic vitreous strands and membrane-like inflammatory material within the vitreous cavity. The membranes are evaluated dynamically to determine their relationship to the retina.
02 Ultrasound Image
03 Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Membranes | Thin-to-moderately echogenic vitreous strands or membranes are present. |
| Organization | Inflammatory material may form interconnected strands or sheets. |
| Mobility | Membranous echoes may show variable mobility with ocular movement. |
| Retinal relationship | The vitreous membranes should be distinguished from the retinal surface. |
| Associated findings | Assess for traction, hemorrhage, detachment or other posterior segment abnormalities. |
04 Ultrasound Report
Multiple echogenic vitreous strands/membrane-like echoes are seen.
The membranes demonstrate variable mobility on dynamic examination.
No definite retinal detachment is identified on the examined views.
05 Impression
Sonographic Impression
Membranous vitreous inflammatory changes compatible with vitritis.
06 Recommendation
Ophthalmic correlation is recommended. Carefully evaluate the vitreoretinal interface and retina for associated pathology.
07 Learning Points
Recognize membrane formation in vitreous inflammation.
Assess membrane mobility.
Distinguish vitreous membranes from retinal detachment.
Look for tractional complications.
Chapter 07 • Case Study
Focal / Localized Vitritis
01 Clinical History
B-scan demonstrates a localized cluster of vitreous echoes rather than uniform involvement of the entire vitreous cavity. Dynamic assessment evaluates the focal opacity and surrounding vitreous.
02 Ultrasound Image
03 Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Focal opacity | A localized cluster of echogenic vitreous material is present. |
| Margins | The focal area may have irregular or relatively defined margins. |
| Mobility | The opacity may move independently or together with surrounding vitreous debris. |
| Background vitreous | The remaining vitreous may be relatively clearer. |
| Retina | The adjacent retinal contour should be examined carefully. |
04 Ultrasound Report
A localized echogenic vitreous opacity/cluster is identified.
The opacity demonstrates mobility on dynamic examination.
No definite retinal detachment is identified on the examined views.
05 Impression
Sonographic Impression
Focal vitreous inflammatory opacity compatible with localized vitritis.
06 Recommendation
Correlate with ophthalmic examination to identify the underlying cause and to assess adjacent retinal structures.
07 Learning Points
Recognize localized vitreous inflammation.
Compare focal and diffuse distributions.
Assess mobility and exact location.
Inspect the adjacent retina carefully.
Chapter 08 • Case Study
Organized Vitritis
01 Clinical History
B-scan demonstrates organized echogenic vitreous debris with strand-like or membrane-like architecture, suggesting a more established inflammatory process.
02 Ultrasound Image
03 Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Organization | Vitreous echoes form strands, aggregates or partially organized membranes. |
| Echo pattern | Internal echogenicity is heterogeneous rather than purely particulate. |
| Mobility | Organization may reduce free mobility compared with fine particulate debris. |
| Vitreous cavity | Residual clearer vitreous may surround the organized material. |
| Retina | Assess carefully for traction or retinal detachment. |
04 Ultrasound Report
Heterogeneous organized echogenic vitreous material is visualized.
Internal strands/aggregates demonstrate limited to moderate mobility.
No definite retinal detachment is identified on the examined views.
05 Impression
Sonographic Impression
Organized vitreous inflammatory debris compatible with established vitritis.
06 Recommendation
Correlate with ophthalmic findings. Evaluate the vitreoretinal interface for traction and associated retinal pathology.
07 Learning Points
Recognize organization of vitreous inflammatory material.
Compare mobility with fine particulate vitritis.
Look for tractional relationships.
Exclude retinal detachment.
Chapter 09 • Case Study
Chronic / Established Vitritis
01 Clinical History
B-scan demonstrates persistent vitreous echogenicity with established particulate and/or membranous material in a patient with a chronic inflammatory clinical history.
02 Ultrasound Image
03 Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Echoes | Persistent low-to-medium level vitreous echoes are present. |
| Organization | Chronic cases may demonstrate strands or partially organized membranes. |
| Mobility | Mobility may be reduced when inflammatory material becomes organized. |
| Vitreous | The vitreous remains incompletely anechoic. |
| Retina | Assess for chronic tractional or retinal complications. |
04 Ultrasound Report
Persistent vitreous echogenic material is present throughout the examined cavity.
Associated strands/organized debris demonstrate variable mobility.
No definite retinal detachment is identified on the examined views.
05 Impression
Sonographic Impression
Chronic/established vitreous inflammatory changes compatible with vitritis.
06 Recommendation
Correlate with the ophthalmic examination and clinical history. Assess for chronic vitreoretinal interface abnormalities.
07 Learning Points
Recognize established vitreous inflammatory changes.
Assess organization and mobility.
Evaluate for tractional complications.
Separate vitreous membranes from retinal pathology.
Chapter 10 • Case Study
Severe Vitritis with Marked Opacification
01 Clinical History
B-scan demonstrates extensive high-density vitreous echoes with marked reduction of vitreous clarity. Dynamic examination is used to assess internal mobility and to evaluate the obscured retina.
02 Ultrasound Image
03 Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Echo density | Marked medium-to-high level echogenicity fills much of the vitreous cavity. |
| Distribution | Opacification is extensive and may be heterogeneous. |
| Mobility | Internal echoes show variable mobility with ocular movement. |
| Visualization | Posterior segment visualization may be significantly limited. |
| Retina | Systematic dynamic scanning is important to assess the retinal contour. |
04 Ultrasound Report
Marked heterogeneous vitreous echogenicity is present with extensive internal debris.
Mobile and partially organized echoes are identified on dynamic examination.
The retina is assessed in multiple planes with no definite detachment identified in the visualized portions.
05 Impression
Sonographic Impression
Severe vitreous inflammatory opacification compatible with marked vitritis.
06 Recommendation
Prompt ophthalmic correlation is recommended. Evaluate for associated retinal, choroidal and infectious/inflammatory pathology according to the clinical setting.
07 Learning Points
Recognize severe vitreous opacification.
Use dynamic scanning despite reduced visualization.
Assess all visible retinal quadrants.
Correlate ultrasound severity with clinical examination.
Chapter 11 • Case Study
Intermediate / Mixed Vitritis
01 Clinical History
B-scan demonstrates a mixture of fine particulate echoes, clustered debris and short vitreous strands, producing a heterogeneous inflammatory appearance.
02 Ultrasound Image
03 Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Mixed echoes | Fine particles coexist with larger echogenic aggregates. |
| Strands | Short vitreous strands may be interspersed among the particulate debris. |
| Distribution | The pattern may be diffuse with variable regional density. |
| Mobility | Different components demonstrate different degrees of mobility. |
| Retina | Assess the retinal contour independently from the mixed vitreous echoes. |
04 Ultrasound Report
Mixed fine particulate, clustered and strand-like vitreous echoes are present.
The internal components demonstrate variable mobility on dynamic examination.
No definite retinal detachment is identified on the examined views.
05 Impression
Sonographic Impression
Mixed vitreous inflammatory debris compatible with intermediate/mixed vitritis.
06 Recommendation
Correlate with ophthalmic examination and clinical history. Evaluate for associated vitreous hemorrhage, traction or retinal pathology.
07 Learning Points
Recognize mixed inflammatory echo patterns.
Assess each component dynamically.
Avoid interpreting all vitreous echoes as a single structure.
Search systematically for associated pathology.
Chapter 12 • Case Study
Complex Vitritis with Membranous / Clumped Debris
01 Clinical History
B-scan demonstrates complex heterogeneous vitreous inflammatory material comprising particulate echoes, clumped debris and membrane-like strands. Dynamic examination is essential to establish the vitreous origin of the abnormalities.
02 Ultrasound Image
03 Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Complexity | Multiple echo patterns coexist within the vitreous cavity. |
| Clumped material | Compact echogenic aggregates may coexist with fine debris. |
| Membranes | Interconnecting strands or membranes may be present. |
| Mobility | Different components show variable mobility. |
| Retinal relationship | The retinal contour must be distinguished from the complex vitreous material. |
04 Ultrasound Report
Complex heterogeneous vitreous echogenic material is present with particulate, clumped and membranous components.
The internal components demonstrate variable mobility on dynamic examination.
No definite retinal detachment is identified in the visualized portions of the globe.
05 Impression
Sonographic Impression
Complex vitreous inflammatory changes compatible with advanced/organized vitritis in the appropriate clinical setting.
06 Recommendation
Ophthalmic correlation is recommended. Carefully assess the vitreoretinal interface, retina and choroid for associated pathology.
07 Learning Points
Recognize multiple coexisting vitreous echo patterns.
Assess each component dynamically.
Distinguish complex vitreous membranes from retinal detachment.
Correlate sonographic complexity with clinical findings.
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