Johnson Steven, Ryan Thomas, Omari Amro, Schneider Samantha, Bahl Amit
Beaumont Hospital, Department of Emergency Medicine, Royal Oak, Michigan.
Beaumont Hospital, Department of Ophthalmology, Royal Oak, Michigan.
Clin Pract Cases Emerg Med. 2022 May;6(2):125-128. doi: 10.5811/cpcem.2022.1.55173.
Approximately two million people present to the emergency department (ED) with eye-related complaints each year in the United States. Differentiating pathologies that need urgent consultation from those that do not is imperative. For some physicians, ocular ultrasound has eclipsed the dilated fundoscopic exam as the standard posterior segment evaluation in the ED.
A 60-year-old female presented with sudden onset visual disturbance in her right eye. Point-of-care ultrasound showed a hyperechoic band in the posterior segment concerning for a retinal detachment. Ophthalmology was consulted and diagnosed the patient with a condition known as Valsalva retinopathy. The patient was discharged from the ED with expectant management.
This case highlights an important differential diagnosis that should be considered when ocular ultrasound demonstrates a hyperechoic band in the posterior segment. While previous literature has demonstrated that emergency physicians are able to accurately identify posterior segment pathology using ultrasound, there is limited information regarding their ability to differentiate between pathologies, some of which may not require urgent consultation. We highlight the important differentials that should be considered when identifying posterior segment pathology on point-of-care ultrasound and their appropriate dispositions.
在美国，每年约有200万人因眼部相关问题前往急诊科就诊。区分需要紧急会诊的病变与无需紧急会诊的病变至关重要。对于一些医生来说，眼部超声已超越散瞳眼底检查，成为急诊科评估眼后段的标准方法。
一名60岁女性因右眼突然出现视力障碍前来就诊。床旁超声显示眼后段有一条高回声带，怀疑视网膜脱离。眼科会诊后诊断该患者患有瓦尔萨尔瓦视网膜病变。患者经观察处理后从急诊科出院。
本病例突出了一个重要的鉴别诊断，当眼部超声显示眼后段有高回声带时应予以考虑。虽然先前的文献表明急诊医生能够使用超声准确识别眼后段病变，但关于他们区分病变的能力的信息有限，其中一些病变可能不需要紧急会诊。我们强调在床旁超声识别眼后段病变时应考虑的重要鉴别诊断及其适当的处理方式。
