Arch Ophthalmol -- Archives of Ophthalmology Clinical Challenge

Retinal Hemorrhage in a 14-Year-Old Boy

REPORT OF A CASE

A 14-year-old boy with blurred vision of recent onset was examined in the eye department. Visual acuity was 6/48 OD and 6/18 OS. Examination revealed bilateral extensive retinal hemorrhages over the posterior pole involving all retinal layers (Figure). The patient’s right eye had a dome-shaped cavity centered over the macula. This cavity was filled with fluid blood and surrounded by a raised ridge outlined by a shiny retinal reflex resembling a perimacular fold (Figure, A). The patient had no history of head injury and no signs of intracranial hemorrhage.

What is your diagnosis?

Figure. Fundus photographs showing extensive retinal hemorrhages over the posterior poles of both eyes. A, The right eye has a dome-shaped cavity centered over the macula. The cavity is filled with fluid blood and surrounded by a raised ridge outlined by a shiny retinal reflex resembling a perimacular fold (arrow). B, The left eye has superficial flame-shaped hemorrhages and a premacular hemorrhage. No perimacular fold is present.
View a larger version of Figure 1

Please e-mail your diagnosis to ophthquiz{at}ama-assn.org. You must include your full name, mailing address, and institutional affiliation in the initial e-mail to be eligible to enter the quiz. The first correct respondent will be recognized in the print journal and on our Web site and will also be able to choose one of the following books published by AMA Press: Clinical Eye Atlas, Clinical Retina, or Users' Guides to the Medical Literature. Because of the volume of responses we are able to respond to the first person with the correct answer only.

For a complete presentation of this case and an in-depth discussion of the entity, please see next month's edition of Archives of Ophthalmology.

Congratulations to the winners of our September quiz, Vinod Kumar, MS, FRCS(Glasg), Wrexham Maelor Hospital, Wrexham, Wales, and Neha Goel, MS, Guru Nanak Eye Centre, New Delhi, India.

The correct answer to our September challenge was toxoplasmosis.

For a complete discussion of this case, see the Small Case Series section in the October Archives (de Souza EC, Casella AMB. Clinical and tomographic features of macular punctate outer retinal toxoplasmosis. Arch Ophthalmol. 2009;127[10]:1390-1394).

Next month's quiz will be available on November 9, 2009, at 3 pm Central time.

Vol 127, No 10, October 2009

Archives Clinical Challenge: You Make the Diagnosis


	Vol 127, No 10, October 2009 Archives Clinical Challenge: You Make the Diagnosis Retinal Hemorrhage in a 14-Year-Old Boy REPORT OF A CASE A 14-year-old boy with blurred vision of recent onset was examined in the eye department. Visual acuity was 6/48 OD and 6/18 OS. Examination revealed bilateral extensive retinal hemorrhages over the posterior pole involving all retinal layers (Figure). The patient’s right eye had a dome-shaped cavity centered over the macula. This cavity was filled with fluid blood and surrounded by a raised ridge outlined by a shiny retinal reflex resembling a perimacular fold (Figure, A). The patient had no history of head injury and no signs of intracranial hemorrhage. What is your diagnosis? Figure. Fundus photographs showing extensive retinal hemorrhages over the posterior poles of both eyes. A, The right eye has a dome-shaped cavity centered over the macula. The cavity is filled with fluid blood and surrounded by a raised ridge outlined by a shiny retinal reflex resembling a perimacular fold (arrow). B, The left eye has superficial flame-shaped hemorrhages and a premacular hemorrhage. No perimacular fold is present. View a larger version of Figure 1 Please e-mail your diagnosis to ophthquiz{at}ama-assn.org. You must include your full name, mailing address, and institutional affiliation in the initial e-mail to be eligible to enter the quiz. The first correct respondent will be recognized in the print journal and on our Web site and will also be able to choose one of the following books published by AMA Press: Clinical Eye Atlas, Clinical Retina, or Users' Guides to the Medical Literature. Because of the volume of responses we are able to respond to the first person with the correct answer only. For a complete presentation of this case and an in-depth discussion of the entity, please see next month's edition of Archives of Ophthalmology. Congratulations to the winners of our September quiz, Vinod Kumar, MS, FRCS(Glasg), Wrexham Maelor Hospital, Wrexham, Wales, and Neha Goel, MS, Guru Nanak Eye Centre, New Delhi, India. The correct answer to our September challenge was toxoplasmosis. For a complete discussion of this case, see the Small Case Series section in the October Archives (de Souza EC, Casella AMB. Clinical and tomographic features of macular punctate outer retinal toxoplasmosis. Arch Ophthalmol. 2009;127[10]:1390-1394). Next month's quiz will be available on November 9, 2009, at 3 pm Central time.