42 year old American American male with a long standing history of uncontrolled diabetes presented ED with c/o unilateral vision loss. He has had vision loss in the past and has proliferative diabetic retinopathy. Bedside ultrasound revealed several subtle echogenicities floating within the vitreous, suggesting the patient has a vitreous hemorrhage at its early phases. When observing the architecture of the posterior eye, one can observe that the patient has a thickened retina as well as a small retinal detachment. To the right of that, you can make out a hyperechogenic irregularity along the retinal wall, which is likely a fibroproliferative growth. This image is fascinating since it shows both an acute and chronic pathology within the eye.

Some Learning Points and Tips:
1. To help improve your overall image, use copious amounts of gel. Sliding and tilting/fanning will be your best friends to center your image and to look throughout the eye.
2. Dynamic! Vitreous hemorrhages can be subtle during its early stages. Have clips (dynamic images) of the eye while asking the patient to look along the plane of the ultrasound probe, you’ll have an easier time seeing the particles within the vitreous.

De La Hoz Polo, M., Torramilans Lluís, A., Pozuelo Segura, O., Anguera Bosque, A., Esmerado Appiani, C., & Caminal Mitjana, J. M. (2016). Ocular ultrasonography focused on the posterior eye segment: what radiologists should know. Insights into Imaging, 7(3), 351–364.

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