B-scan ultrasonography of an eye with acute severe pain and shallow anterior chamber shows a thick, smooth, convex echogenic membrane that is relatively immobile on dynamic scanning, extends anterior to the ora serrata, and has an underlying hypoechoic space. The most likely diagnosis is:
- A Hemorrhagic choroidal detachment ✓
- B Total rhegmatogenous retinal detachment
- C Posterior vitreous detachment with vitreous hemorrhage
- D Retinoschisis
Correct answer: A. Hemorrhagic choroidal detachment
Explanation
Choroidal detachment appears on A-scan as one or more thick, smooth, dome-shaped or apposed membranes with little or no after-movement, unlike the thin, highly mobile membrane of rhegmatogenous retinal detachment. Two key discriminators are extension anterior to the ora serrata, which a retinal detachment cannot do, and the suprachoroidal contents: hemorrhage is echogenic while exudative fluid may be echo-free. Apposed kissing choroidals carry a poor prognosis and often require surgical drainage.
Reference: Kanski's Clinical Ophthalmology, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.