Clinical details : 30 yrs old female patient presented with lump in abdomen.

Image 1 – B-Scan left orbit.

Image 2 – B-scan Left orbit with Colour Doppler.

Legend: Images 1 and 2 taken from scanning of a patient with penetrating eye trauma show well defined, dome-shaped, thick, relatively fixed membranes from both nasal and temporal sides approximating each other with the overlying biconvex space occupied by significant coarse internal echoes.

Introduction: The eye has three coats: retina, choroid and sclera from within outwards. The sub-retinal space between the retina and choroid and the supra-choroidal space between the choroid and sclera are virtual spaces which are never seen in normal eyes because of their close opposition. As fluid accumulates in these spaces they can become apparent on imaging.

Pathologic Characteristics: Accumulation in the supra-choroidal space causes variable elevation and detachment of choroid from the underlying sclera. The accumulation could be either of serous, exudative or hemorrhagic fluid.

Serous fluid accumulates in condition of increased transmural pressure as in globe hypotony due to any cause. It is relatively painless with a variable degree of vision loss.
Exudative accumulation occurs in choroiditis, although preferential sub-retinal accumulation is usually seen.

Hemorrhagic choroidal detachment is a hemorrhage in the supra-choroidal space or within the choroid caused by the rupture of choroidal vessels. This can occur spontaneously (rare), as a consequence of ocular trauma, during eye surgery, or after eye surgery. The outcome is generally worse for intraoperative hemorrhages, which often are accompanied by loss of eye contents – the so called expulsive hemorrhage which can occur in any form of ocular surgery, but commonly seen in cataract surgeries. Postoperative hemorrhagic detachments are characterized by sudden excruciating throbbing pain with an immediate loss of vision.

Imaging characteristics:
Fluid accumulation in the suprachoroidal space is confined by the attachments of the chroid – anteriorly to ciliary body and hence the scleral spur, posteriorly at the exit foramina of the vortex veins. After the vortex veins are avulsed or if they are absent, the detachment can extend to the optic disc however, usually it stops short in midway and very rarely reaches the optic disc margin.

B-Scan: B-scan very well depicts serous as well as hemorrhagic choroidal detachments. They are seen as well defined, dome-shaped, thick, relatively fixed, choroidal membranes from both sides approximating each other (kissing sign). Being a vascular layer, it shows vascularity on Colour Doppler. Serous detachments show no or insignificant echoes in supra-choroidal space while thick internal echoes may be seen in hemorrhagic detachments.

MRI: Sub-acute hemorrhagic choroidal detachment appears as moderately hyperintense image in T1 weighted and as hypointense in T2 weighted sequences. Chronic hemorrhagic choroidal detachment appears as hyperintense in T1 and T2 weighted images.

Serous choroidal detachment and choroidal effusion appears as moderately hyperintense image in T1 and T2 weighted sequences.
The exudative retinal detachment characteristically appears on MR scans as a dependent hyperintense object in T1 and T2 weighted sequences.

Treatment: Treatment is usually not needed. The hemorrhagic fluid liquefies and gets resorbed usually completely.

Contributed by:
Dr. Rachna Mone

Dr. Krishna Prasad