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Callegari A, Abulfaraj MM. Orbital Mass Identified With Point-of-Care Ultrasound in a Child Presenting With Eyelid Swelling. Pediatr Emerg Care 2024; 40:e174-e175. [PMID: 38713837 DOI: 10.1097/pec.0000000000003163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
ABSTRACT Point-of-care ultrasound was used in a child presenting to the emergency department with progressively worsening left eyelid swelling. The early use of ultrasound was helpful in detecting a soft tissue mass that is exhibiting pressure effect on the eyeball. Point-of-care ultrasound helped expedite advanced imaging and consultation with the specialist. The patient eventually had a biopsy and was diagnosed with idiopathic orbital inflammation.
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Affiliation(s)
- Alison Callegari
- From the Department of Pediatrics, The Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ
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2
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Dos Santos JC, Gorla LFDO, Moreno R, Monnazzi MS, Pereira Filho VA, Gabrielli MFR, Gabrielli MAC. Traumatic Orbital Compression Syndromes: A Comprehensive Study Into Etiologies, Intervention Strategies, and Clinical Outcomes. J Craniofac Surg 2024; 35:1449-1455. [PMID: 38838361 DOI: 10.1097/scs.0000000000010375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Facial fractures and their historical link to potential blindness have been well-documented, often attributed to optic canal injuries or retinal vascular occlusion. This dire consequence can result from both direct and indirect ocular trauma, including retrobulbar hemorrhage. Traumatic orbital compression can manifest in various forms, such as hematomas, fractured bone fragments, and emphysema, all posing a significant threat to vision, necessitating immediate intervention. In this study, 9 clinical cases of traumatic orbital compression are presented, each characterized by distinct etiologies. The study delves into traumatic orbital compressive syndromes, underscoring the critical imperative of early recognition and treatment to prevent vision loss. Orbital compression, whether from edema, hematoma, or emphysema, collectively culminates in elevated intraorbital pressure and the potential for optic nerve ischemia. Through the presentation of these 9 clinical cases, the article emphasizes the pressing need for timely intervention in addressing orbital compressive syndromes to avert vision loss. Various surgical techniques are elucidated, highlighting the pivotal role of expeditious medical intervention. This article offers invaluable insights into the diagnosis, management, and outcomes of traumatic orbital compressive syndromes.
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Affiliation(s)
- José Cleveilton Dos Santos
- Department of Diagnostic and Surgery, School of Dentistry, São Paulo State University (Unesp), Araraquara
| | | | - Roberto Moreno
- Private Clinic Departament, Oral and Maxillofacial Surgeon, São Paulo, Brazil
| | - Marcelo Silva Monnazzi
- Department of Diagnostic and Surgery, School of Dentistry, São Paulo State University (Unesp), Araraquara
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3
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Boruah DK, Vishwakarma D, Gogoi P, Lal NR, Deuri A. Utility of High-Resolution Ultrasonography in the Evaluation of Posterior Segment Ocular Lesions Using Sensitivity and Specificity. Acta Med Litu 2023; 30:171-180. [PMID: 38516520 PMCID: PMC10952424 DOI: 10.15388/amed.2023.30.2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 03/23/2024] Open
Abstract
Background High-resolution Ultrasound (USG) provides good anatomical details of the ocular posterior segment and depicts the various pathological conditions affecting the ocular posterior segment, which helps ophthalmologists for choosing the best treatment options. This study aims to evaluate the utility of High-resolution Ultrasonography in the Evaluation of Posterior Segment Ocular lesions by using Sensitivity and Specificity. Materials and Methods A hospital-based retrospective study enrolled 81 patients in a tertiary care hospital. Clinical and ophthalmological examinations were performed followed by USG of the orbits. B-mode USG was done with a 7.5-13 MHz linear probe. The final diagnosis was made by correlating the USG findings with clinical and ophthalmological examinations. Statistical analysis Sensitivity, specificity, the positive predictive value, the negative predictive value, and the accuracy of B-scan USG were compared with the ophthalmological findings by using the Chi-square test. Results Of 81 patients (n=48 males and n=33 females) with a mean age of 38.98 ± 16.48 [SD] years, posterior segment ocular lesions in association with cataracts were found in 27 (33.3%) patients, whereas 14 (51.9%) patients had posterior vitreous detachment (PVD), 10 (37%) patients had retinal detachment (RD), and 1 (3.7%) patient had choroidal detachment (CD). Posterior segment ocular pathologies were found in 17 (21%) patients with blunt ocular injuries, whereas 8 (47.1%) patients had PVD, 4 (23.5%) patients had RD and 4 (23.5%) patients had CD. The ocular USG had a sensitivity of 87.32%, specificity of 80%, and accuracy of 86.42% with a statistically significant difference between the USG findings and the Ophthalmology diagnosis of the posterior segment ocular abnormalities of a p-value of 0.0005. Conclusion High-resolution ultrasound is one of the best and an easily available imaging modality for the evaluation of posterior segment ocular pathologies, especially in the presence of opaque ocular media.
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Affiliation(s)
- Deb K. Boruah
- All India Institute of Medical Sciences, Guwahati, Assam, India
| | - Daisy Vishwakarma
- Department of Ophthalmology, Assam Medical College & Hospital, Dibrugarh Assam, India
| | - Pallavi Gogoi
- Department of Library and Information Science, DHSK College, Dibrugarh, Assam, India
| | - Navneet R. Lal
- Department of Radio-diagnosis, Assam Medical College & Hospital, Assam, India
| | - Arup Deuri
- Department of Ophthalmology, Lakhimpur Medical College & Hospital, Lakhimpur Assam, India
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4
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Rice JA, Brewer J, Speaks T, Choi C, Lahsaei P, Romito BT. The POCUS Consult: How Point of Care Ultrasound Helps Guide Medical Decision Making. Int J Gen Med 2021; 14:9789-9806. [PMID: 34938102 PMCID: PMC8685447 DOI: 10.2147/ijgm.s339476] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jake A Rice
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jonathan Brewer
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tyler Speaks
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christopher Choi
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peiman Lahsaei
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bryan T Romito
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Correspondence: Bryan T Romito Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9068, USATel +1 214 648 7674Fax +1 214 648 5461 Email
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5
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Caja KR, Griffith KM, Roth KR, Worrilow CC, Greenberg MR, Doherty TB. Detection of Central Retinal Artery Occlusion by Point-of-Care Ultrasound in the Emergency Department: A Case Series. Cureus 2021; 13:e16142. [PMID: 34367764 PMCID: PMC8330491 DOI: 10.7759/cureus.16142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/03/2021] [Indexed: 11/24/2022] Open
Abstract
Central retinal artery occlusion (CRAO) is a rare, but serious, diagnosis that can lead to blindness, most often due to thromboembolic disease. In the emergency department (ED), CRAO can present as acute, painless loss of vision. Physicians need quick ways to rule in this diagnosis due to the time-sensitive nature of the event. We describe two patients in this cases series who present to the same ED with unilateral painless vision loss and histories that include notable risk factors such as thromboembolic and atherosclerotic disease. Upon arrival, point-of-care ultrasound (POCUS) done at the bedside allowed for quick determination of CRAO. The importance of this case series is to emphasize the efficacy of POCUS in evaluating patients with painless vision loss in the ED setting.
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Affiliation(s)
- Kevin R Caja
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Kaylan M Griffith
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Kevin R Roth
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Charles C Worrilow
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Marna R Greenberg
- Department of Emergency Medicine, University of South Florida (USF) Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Theodore B Doherty
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, USA
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6
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Glickman A, Szczucki B, Kalivoda EJ, Furiato A, Cabrera G. Bedside Ocular Ultrasound Diagnosis of a Traumatic Lens Dislocation. Cureus 2021; 13:e14666. [PMID: 33927958 PMCID: PMC8075821 DOI: 10.7759/cureus.14666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rapid identification of ophthalmologic emergencies can be challenging in the ED, and a missed or delayed diagnosis may have vision-threatening consequences. The application of ocular point-of-care ultrasound (POCUS) by the emergency physician (EP) can facilitate the timely recognition of a myriad of emergent eye conditions. This report describes a case in which EP-performed POCUS established the prompt diagnosis of a traumatic lens dislocation in a patient with chronic vision changes.
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Affiliation(s)
- Andrew Glickman
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
| | - Brian Szczucki
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
| | - Eric J Kalivoda
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
| | - Anthony Furiato
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
| | - Gabriel Cabrera
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
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Pyle M, Gallerani C, Weston C, Frasure SE, Pourmand A. Point of care ultrasound and ocular injuries: A case of lens dislocation and a comprehensive review of the literature. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:282-285. [PMID: 32783263 DOI: 10.1002/jcu.22904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/30/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
Point-of-care ultrasound (POCUS) can help the clinician diagnose different ocular pathologies including retinal detachment, vitreous detachment, lens dislocation, and intraocular foreign bodies. Ocular pathologies such as blurry vision, double vision, loss of vision, and eye trauma are common chief complaints and require a comprehensive evaluation in order to determine the etiology and choose the correct treatment. Specifically ultrasound can help the clinician decide whether an urgent ophthalmology consult is appropriate. We present a case in which a lens dislocation was diagnosed using POCUS and review the available literature.
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Affiliation(s)
- Matthew Pyle
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Christina Gallerani
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Christopher Weston
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Sarah E Frasure
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Ali Pourmand
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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8
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Hoffmann B, Schafer JM, Dietrich CF. Emergency Ocular Ultrasound - Common Traumatic and Non-Traumatic Emergencies Diagnosed with Bedside Ultrasound. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:618-645. [PMID: 33291171 DOI: 10.1055/a-1246-5984] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Point-of-care ocular ultrasound (POCOUS) in the ambulatory and critical care setting has become an invaluable diagnostic tool for patients presenting with traumatic or atraumatic vision and ocular complaints. Sonographic bedside evaluation is intuitive and easy to perform and can accurately diagnose a variety of pathologies. These include detachment or hemorrhage of the retina or vitreous, lens dislocation, retrobulbar hematoma or air, as well as ocular foreign bodies, infections, tumors, and increased optic nerve sheath diameter that can be assessed in the setting of suspected increased intracranial pressure. The ocular anatomy is easy to visualize with sonography, as the eye is a superficial structure filled with fluid. Over the last two decades, a large number of scientific publications have documented that POCOUS in emergent or critical care settings is an accurate diagnostic tool and expands and improves emergency diagnosis and management. This article will review POCOUS exam techniques as well as normal sonographic findings and common pathologies.
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Affiliation(s)
- Beatrice Hoffmann
- Department of Emergency Medicine, Division of Emergency Ultrasound, Beth Israel Deaconess Medical Center, Boston, United States
| | - Jesse M Schafer
- Department of Emergency Medicine, Division of Emergency Ultrasound, Beth Israel Deaconess Medical Center, Boston, United States
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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9
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Aspide R, Bertolini G, Albini Riccioli L, Mazzatenta D, Palandri G, Biasucci DG. A Proposal for a New Protocol for Sonographic Assessment of the Optic Nerve Sheath Diameter: The CLOSED Protocol. Neurocrit Care 2020; 32:327-332. [PMID: 31583527 DOI: 10.1007/s12028-019-00853-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Measuring and monitoring of intracranial pressure is considered standard of care in patients with suspected intracranial hypertension. Sonographic assessment of the optic nerve sheath diameter (ONSD) has been promising and potentially useful for noninvasive intracranial hypertension screening. ONSD measurements are easy to perform, repeatable at bedside, fast, low cost, and radiation-free. However, they are still burdened by inter-rater variability, lack of ultrasound (US) setting standardization (e.g., US frequency, focus depth, etc.), and possible artifacts. To overcome this problem, we propose the CLOSED protocol associated with equipment specifications, as a guide to minimize the occurrence of such artifacts enabling a more reliable and accurate measurement. We suggest that color Doppler could be used as a new standard evaluation for the ONSD.
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Affiliation(s)
- Raffaele Aspide
- Anesthesia and Neurointensive Care Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy.
| | - Giacomo Bertolini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Luca Albini Riccioli
- Neuroradiology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giorgio Palandri
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Daniele Guerino Biasucci
- Neurointensive Care Unit, Department of Emergency, Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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10
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Lahham S, Ali Q, Palileo BM, Lee C, Fox JC. Role Of Point Of Care Ultrasound In The Diagnosis Of Retinal Detachment In The Emergency Department. Open Access Emerg Med 2019; 11:265-270. [PMID: 32009820 PMCID: PMC6859292 DOI: 10.2147/oaem.s219333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 10/23/2019] [Indexed: 11/23/2022] Open
Abstract
Ocular complaints represent up to 3% of all emergency department (ED) visits. These presentations can result in permanent vision loss if not promptly diagnosed and treated. Recently, point of care ultrasound (POCUS) has been investigated for the evaluation of ocular pathology in the ED. Multiple studies have investigated the role that ultrasound may play in the early diagnosis of these patients. Ocular ultrasound can be used to visualize the structures of the eye and evaluate for pathology such as retinal detachment, vitreous hemorrhage and vitreous detachment. This comprehensive review aims to present current evidence for the efficacy and reliability of ED ocular ultrasound use in the detection of retinal detachment and additional ocular pathologies.
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Affiliation(s)
- Shadi Lahham
- University of California, Irvine, Department of Emergency Medicine, Orange, CA92868, USA
| | - Qumber Ali
- Touro University, School of Medicine, Henderson, NV89014, USA
| | - Bea Martina Palileo
- University of California, Riverside, School of Medicine, Riverside, CA92521, USA
| | - Clifton Lee
- University of California, Riverside, School of Medicine, Riverside, CA92521, USA
| | - John C Fox
- University of California, Irvine, Department of Emergency Medicine, Orange, CA92868, USA
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11
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Li TT, Shao GB, Jiang YL, Wang JX, Zhou XR, Ren M, Li LQ. Ocular surface heat effects on ocular hemodynamics detected by real-time measuring device. Int J Ophthalmol 2018; 11:1902-1908. [PMID: 30588420 DOI: 10.18240/ijo.2018.12.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 10/15/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the ocular hemodynamic effects of applying a hot compress to the eye. METHODS The right eyes of five New Zealand white rabbits, both male and female, were hot-compressed for 18min. An independently designed novel ocular contact-type temperature measuring device was used to measure the ocular surface temperature before and after the heating. Relevant retrobulbar hemodynamic parameters such as peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) of each of the central retinal artery (CRA), long posterior ciliary artery (LPCA), and ophthalmic artery (OA), as well as the mean velocity (Vm) of the central retinal vein (CRV), were measured using a color Doppler flow imaging (CDFI) technique and expressed as mean values with standard deviation (mean±SD). A statistical analysis was conducted based on a paired t-test and the Wilcoxon signed-rank test. RESULTS The employed real-time temperature measuring device was able to accurately measure ocular surface temperature during the hot-compress process. The temperature increased after the hot compress was applied. Analysis showed that the PSV and EDV values of the CRA and LPCA significantly increased after the application of the hot compress, as did the Vm of the CRV. There were no significant changes in the EDV of the OA nor the RI of each artery. CONCLUSION This experiment, which is the first of its kind, confirms that the retrobulbar blood flow velocities can increase upon heating the ocular surface. This simple method may be useful in the future.
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Affiliation(s)
- Ting-Ting Li
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (originally named "Shanghai First People's Hospital"), Shanghai 200080, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai 200080, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai 200080, China.,Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
| | - Guang-Bin Shao
- Key Laboratory of Micro-systems and Microstructures Manufacturing of Ministry of Education, Harbin Institute of Technology, Harbin 150001, Heilongjiang Province, China
| | - Yu-Long Jiang
- Key Laboratory of Micro-systems and Microstructures Manufacturing of Ministry of Education, Harbin Institute of Technology, Harbin 150001, Heilongjiang Province, China
| | - Jing-Xuan Wang
- Key Laboratory of Micro-systems and Microstructures Manufacturing of Ministry of Education, Harbin Institute of Technology, Harbin 150001, Heilongjiang Province, China
| | - Xin-Rong Zhou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (originally named "Shanghai First People's Hospital"), Shanghai 200080, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai 200080, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai 200080, China.,Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
| | - Min Ren
- Department of Ultrasound, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Long-Qiu Li
- Key Laboratory of Micro-systems and Microstructures Manufacturing of Ministry of Education, Harbin Institute of Technology, Harbin 150001, Heilongjiang Province, China
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12
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Sonography in acute ocular pathology: a kaleidoscopic view. Emerg Radiol 2018; 26:241-248. [DOI: 10.1007/s10140-018-1655-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/02/2018] [Indexed: 11/24/2022]
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13
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Gonzalez LK, Yellin S, Arroyo AC. Point-of-Care Ultrasound in the Pediatric Emergency Department: Where We're at, Where We're Going. Adv Pediatr 2018; 65:121-142. [PMID: 30053920 DOI: 10.1016/j.yapd.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Laura K Gonzalez
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, 4082 10th Avenue, Brooklyn, NY 11219, USA
| | - Sharon Yellin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, USA
| | - Alexander C Arroyo
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, 4082 10th Avenue, Brooklyn, NY 11219, USA.
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14
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Abstract
Point-of-care ocular ultrasound can provide the clinician with more information about potential intraorbital and extraocular pathology, especially in cases when direct visualization of the eye is limited. This case report describes the findings in a pediatric patient who presented with a 1-month history of eye injection and worsening blurry vision. After point-of-care ultrasound demonstrated abnormal debris in the posterior vitreous cavity, subsequent evaluation revealed a diagnosis of pars planitis.
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15
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Jarrett B, Secko M. Choroid Detachment, a Rare Cause of Vision Loss Diagnosed by Point-of-Care Ultrasound. J Emerg Med 2016; 52:527-529. [PMID: 27712896 DOI: 10.1016/j.jemermed.2016.07.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/14/2016] [Accepted: 07/30/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Choroid detachment is a rare disease process that has a multitude of etiologies; usually related to recent ophthalmological surgery, eye trauma, corneal ulcers, or intraocular pressure-lowering agents. Point-of-care ocular ultrasound has high utility and accuracy in diagnosing pathology of the eye. CASE REPORT We present a case of a patient who presented with vision loss caused by a choroid detachment diagnosed on point-of-care ultrasound because fundoscopic examination was limited due to cataracts. Ultrasound findings based on location and appearance during both static and dynamic evaluation that help differentiate a choroid vs. a retinal detachment are also described. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Choroid detachments have a different sonographic appearance, as well as management, compared to a retinal detachment.
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Affiliation(s)
- Brian Jarrett
- Department of Emergency Medicine, Kings County Hospital Center/SUNY Downstate Medical Center, Brooklyn, New York
| | - Michael Secko
- Department of Emergency Medicine, Kings County Hospital Center/SUNY Downstate Medical Center, Brooklyn, New York
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16
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De La Hoz Polo M, Torramilans Lluís A, Pozuelo Segura O, Anguera Bosque A, Esmerado Appiani C, Caminal Mitjana JM. Ocular ultrasonography focused on the posterior eye segment: what radiologists should know. Insights Imaging 2016; 7:351-64. [PMID: 26910565 PMCID: PMC4877345 DOI: 10.1007/s13244-016-0471-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/23/2016] [Accepted: 01/26/2016] [Indexed: 11/29/2022] Open
Abstract
Abstract Ocular B-mode ultrasonography (US) is an important adjuvant for the clinical assessment of a variety of ocular diseases. When ophthalmoscopy is not possible, mainly due to opacification of the transparent media (e.g., mature cataract or vitreous haemorrhage), US can guide the ophthalmologist in diagnosing disease and choosing treatment. The superficial location and cystic structure of the eye make US ideal for imaging of the eye. Moreover, dynamic study helps distinguish between various conditions that would otherwise be difficult to differentiate in some clinical setting, such as vitreous, retinal, and choroidal detachment. US is also good technique for detecting other pathologic conditions such as lens dislocation, vitreous haemorrhage, asteroid hyalosis, optic disc drusen, and tumors (e.g., choroidal melanoma, metastases, hemangioma). An understanding of the basic anatomy of the eye, the US technique, and common entities that affect the ocular globe will allow radiologists to offer this valuable imaging modality to patients and referring clinicians. This article focuses on the US anatomy and pathologic conditions that affect the posterior ocular segment. Teaching points • US is specially indicated when ocular fundus cannot be assessed on ophthalmoscopy. • Multipurpose equipment with high-frequency transducers is optimal for imaging the eye. • Ultrasound can reliably depict ocular anatomy and pathology as detachments and tumours. • Dynamic examination is vital for distinguishing certain pathologic conditions as detachments. Electronic supplementary material The online version of this article (doi:10.1007/s13244-016-0471-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marcela De La Hoz Polo
- Radiology Department, Hospital Sant Pau i Santa Tecla, Rambla Vella 14, 43003, Tarragona, Spain. .,Hospital El Vendrell, Carretera de Barcelona, s/n, 43700, El Vendrell, Spain.
| | | | - Oscar Pozuelo Segura
- Radiology Department, Hospital Sant Pau i Santa Tecla, Rambla Vella 14, 43003, Tarragona, Spain.,Hospital El Vendrell, Carretera de Barcelona, s/n, 43700, El Vendrell, Spain
| | - Albert Anguera Bosque
- Radiology Department, Hospital Sant Pau i Santa Tecla, Rambla Vella 14, 43003, Tarragona, Spain.,Hospital El Vendrell, Carretera de Barcelona, s/n, 43700, El Vendrell, Spain
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17
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18
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Abstract
The use of point-of-care ultrasound in the pediatric emergency department is evolving beyond conventional applications as users become more expert with the technology. In this case series, we describe the potential utility of recognizing abnormal anatomy to impact care in the context of possible cancer in pediatric patients. We describe 4 patients with Langerhans histiocytosis, neuroblastoma, Wilms tumor, and rhabdomyosarcoma, in which point-of-care ultrasound was used to facilitate the diagnoses.
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Boniface KS, Aalam A, Salimian M, Liu YT, Shokoohi H. Trauma-Induced Bilateral Ectopia Lentis Diagnosed with Point-of-Care Ultrasound. J Emerg Med 2015; 48:e135-7. [DOI: 10.1016/j.jemermed.2015.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/03/2015] [Accepted: 01/05/2015] [Indexed: 10/23/2022]
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20
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Kniess CK, Fong TC, Reilly AJ, Laoteppitaks C. Early Detection of Traumatic Retrobulbar Hemorrhage Using Bedside Ocular Ultrasound. J Emerg Med 2015; 49:58-60. [PMID: 25797939 DOI: 10.1016/j.jemermed.2014.12.074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 12/13/2014] [Accepted: 12/22/2014] [Indexed: 10/23/2022]
Affiliation(s)
- Carol Katherine Kniess
- Department of Emergency Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Tiffany C Fong
- Department of Emergency Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Aaron J Reilly
- Department of Emergency Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Chaiya Laoteppitaks
- Department of Emergency Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
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