Pediatric Ocular Sonography

Utility of High-Resolution Ultrasonography in the Evaluation of Posterior Segment Ocular Lesions Using Sensitivity and Specificity

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.

Radiologic diagnosis of non-traumatic paediatric head and neck emergencies

Imaging plays a crucial role in evaluating paediatric patients with non-traumatic head and neck lesions in an emergency setting because clinical manifestations of these entities can overlap. For this reason, radiologists must be familiar with the clinical and imaging findings of prevalent paediatric head and neck emergencies. In this review, we present techniques and imaging clues for common complications of pathological processes in the paediatric head and neck, with a focus on the clinical scenario as a starting point for the radiologic approach.

Paediatric orbital ultrasound: Tips and tricks

Background

The orbital structures are ideally suited for ultrasound examination due to their superficial location and cystic composition of the eye. However, orbital ultrasound remains an underutilised modality due to preference for other cross-sectional modalities in general practice.

Aim

In this article, we review the basic principles, clinical uses and technique of orbital ultrasound in peadiatric patients.

Materials and methods

The clinical utility of orbital ultrasound in peadiatric patients is demonstrated using selected cases.

Results

Ultrasound is useful in the diagnosis of various posterior segment pathologies, especially in conditions causing opacification of light-conducting media of the eye. It is also beneficial in diagnosing various orbital pathologies, particularly in differentiating solid from cystic lesions.

Discussion

The added advantages of its use in children include lack of ionising radiation and reduced requirement of sedation or general anesthesia. Ultrasound is the most practical initial investigation in cases where ophthalmoscopy is limited by opacification of ocular media. The addition of color Doppler on ultrasound can give additional information about the vascularity of the lesion.

Conclusion

Use of ultrasound can be streamlined into the workup of various orbital and ocular pathologies either as an initial investigation or as a problem-solving tool in cases with a diagnostic dilemma on other modalities.

Imaging the pediatric retina: An overview

Recent decade has seen a shift in the causes of childhood blinding diseases from anterior segment to retinal disease in both developed and developing countries. The common retinal disorders are retinopathy of prematurity and vitreoretinal infections in neonates, congenital anomalies in infants, and vascular retinopathies including type 1 diabetes, tumors, and inherited retinal diseases in children (up to 12 years). Retinal imaging helps in diagnosis, management, follow up and prognostication in all these disorders. These imaging modalities include fundus photography, fluorescein angiography, ultrasonography, retinal vascular and structural studies, and electrodiagnosis. Over the decades there has been tremendous advances both in design (compact, multifunctional, tele-consult capable) and technology (wide- and ultra-wide field and noninvasive retinal angiography). These new advances have application in most of the pediatric retinal diseases though at most times the designs of new devices have remained confined to use in adults. Poor patient cooperation and insufficient attention span in children demand careful crafting of the devices. The newer attempts of hand-held retinal diagnostic devices are welcome additions in this direction. While much has been done, there is still much to do in the coming years. One of the compelling and immediate needs is the pediatric version of optical coherence tomography angiography. These needs and demands would increase many folds in future. A sound policy could be the simultaneous development of adult and pediatric version of all ophthalmic diagnostic devices, coupled with capacity building of trained medical personnel.

Retinal imaging in infants

Digital retinal imaging is at the core of a revolution that is continually improving the screening, diagnosis, documentation, monitoring, and treatment of infant retinal diseases. Historically, imaging the retina of infants had been limited and difficult to obtain. Recent advances in photographic instrumentation have significantly improved the ability to obtain high quality multimodal images of the infant retina. These include color fundus photography with different camera angles, ultrasonography, fundus fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography. We provide a summary of the current literature on retinal imaging in infants and highlight areas where further research is required.

Ocular echobiometry and head measurements in Jersey cattle from different age groups

A longitudinal study was conducted to identify the morphological development of eyes and head of Jersey cattle at different ages. A total of 48 healthy Jersey cattle, 1 to 58 months of age, were included in the study. Ophthalmologic examinations were performed to identify healthy cattle to form the age groups: GI (1- to 11-month-old), GII (16- to 24-month-old) and GIII (25- to 58-month-old). The animals were physically restrained and examined by transcorneal ultrasound of both eyes; the axial length (AxL), corneal thickness (CO), lenticular thickness (L), depth of the anterior (AC) and vitreous (VC) chambers were evaluated. The cranial measurements obtained included the total, cranial, and nasal lengths and widths. Subsequently, the cephalic index (CI) was calculated. The AxL (GI: 2.83 cm; GII: 3.16 cm; GIII: 3.24 cm), AC (GI: 0.44 cm; GII: 0.53 cm; GIII: 0.53 cm), L (GI: 0.88 cm; GII: 1.01 cm; GIII: 1.04 cm) and VC (GI: 1.44 cm; GII: 1.55 cm; GIII: 1.59 cm) increased (p ≤ .001) according to age, but the CO (GI: 0.07 cm; GII: 0.08 cm; GIII: 0.08 cm) (p > .05) did not. The total length (GI: 30.83 cm; GII: 43.29 cm; GIII: 44.15 cm), cranial length (GI: 18.11 cm; GII: 23.82 cm; GIII: 22.69 cm), nasal length (GI: 12.72 cm; GII: 19.47 cm; GIII: 21.46 cm) and nasal width (GI: 26.22 cm; GII: 33.82 cm; GIII: 34.00 cm) increased (p < .001), and the CI (GI: 85.66 cm; GII: 78.15 cm; GIII: 77.02 cm) decreased (p < .001). The AxL correlated positively (p < .001) with the cranial length and width and negatively with the CI (p > .05). The ocular biometry of Jersey cattle correlates with their cranial measurements at different ages. With increasing age, the eyes and the head grow, establishing growth curves similar to those of other mammals.

Child With Red Eye and Blurry Vision

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.

Point-of-Care Ultrasound Diagnosis of Bilateral Retinal Detachment Associated With Vogt-Koyanagi-Harada Disease in the Pediatric Emergency Department

We report a case of a 16-year-old girl with acute visual complaints who was diagnosed with bilateral retinal detachment using point-of-case ultrasound and ultimately was diagnosed with Vogt-Koyanagi-Harada disease. This case illustrates the use of point-of-care ultrasound by the pediatric emergency physician to recognize the ocular abnormality associated with this rare disease.

Sonographic Detection of Unilateral Retinoblastoma

Retinoblastoma is a cancer that affects the eye, and if untreated, it can spread to other parts of the body. Retinoblastoma is the most common pediatric eye cancer and accounts for 3% of all childhood cancers. It can be hereditary or sporadic (nonhereditary). This case study presents a unilateral retinoblastoma of the right eye in a pediatric patient. A diagnosis of retinoblastoma was made by correlating sonography, magnetic resonance imaging, and ophthalmology. Treatment for retinoblastoma depends on the severity of the cancer but can include radiation, chemotherapy, focal laser therapy, and/or surgery. This particular case of retinoblastoma was treated with chemotherapy.

Ocular ultrasonography focused on the posterior eye segment: what radiologists should know

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.

Emergency department bedside ultrasound diagnosis of retinoblastoma in a child

A 30-month-old boy presented to a Haitian emergency department with proptosis, periorbital edema, and progressive blindness. Bedside ultrasound examination revealed bilateral ocular masses with dense calcifications pathognomonic for retinoblastoma. This case illustrates the diagnostic utility of bedside ultrasound for an advanced case of retinoblastoma in a resource-poor setting. Ocular ultrasound technique is also reviewed.