Neuroradiology Case of the Week

Case 11

Andrea Zynda-Weiss, MD and P-L Westesson, MD, PhD, DDS

Clinical Presentation: A 32-year-old male presented after pliers flew into his left eye. Clinically, globe rupture was suspected.

Radiographic Findings: There is vitreous hemorrhage in the left globe with choroidal detachment.

Figure 1A	Figure 1B
Figure 1A&B: Axial and reconstructed coronal images demonstrate choroidal hemorrhage and proptosis.

Diagnosis: Globe rupture with choroidal detachment.

Discussion: Choroidal detachment is caused by the accumulation of fluid or blood in the potential suprachoroidal space [2,3]. Hemorrhagic choroidal detachment occurs after a contusion, penetrating ocular trauma, as in this case, or as a complication of ocular surgery. Vitreous hemorrhage and hyphema limit visualization of the fundus. Choroidal detachment significantly affects the prognosis of the injured eye [2]. Ultrasound, CT and MRI can all be performed to evaluate ocular injuries. CT is the best-suited modality for evaluation of a lacerated globe [1].
   Hemorrhagic choroidal detachment appears as a mound-like area of high intensity on CT. MRI is also an excellent modality for evaluating patients with choroidal detachment. MRI shows choroidal hematoma as a focal, well-demarcated lenticular mass in the wall of the eyeball. The signal intensity of a hematoma depends on its age. Within the first 48 hours the hematoma is iso-intense to slightly hypointense to the normal vitreous body in T1-weighted MRI images. After 5 days choroidal hematoma appears hyperintense on T1-weighted images. Hematoma usually continues to increase signal intensity on T1-weighted images and T2-weighted images and becomes markedly hyperintense by two weeks on all MR sequences [2,3].
   Serous choroidal effusion is the result of ocular hypotonia secondary to accidental perforation of the eye, as in this case, inflammatory disease such as uveitis or scleritis, ocular surgery or intensive glaucoma therapy. A choroidal effusion is seen as a cresentic or ring-shaped lesion on CT and MRI [2,3]. It is not always possible to differentiate choroidal detachment from retinal detachment since the distinction of choroidal effusion from sub-retinal effusion is difficult [3,4].

TREATMENT: The patient was treated surgically with evisceration of the globe. Operatively, he was found to have a corneal laceration with extruded retina and uveal tissues.

References:

1. Som P, Curtain HD. Head and Neck Imaging, 3rd Ed., Mosby 1996.
2. Mafee MF, Peyman GA. Choroidal detachment and ocular hypotony: CT evaluation. Radiology 1984;153:697-703.
3. Mafee MF, Linder B, Peyman GA, et al. Choroidal hematoma and effusion: evaluation with MR imaging. Radiology 1988;168:781-786.
4. Peyman GA, Mafee MF, Shulman JA. Computed tomography and choroidal detachment. Opthalmology 1984;91:156-162.