show only a single-peaked spike on B-scan (Fig. 6B). Ultrasound can be used to differentiate between serous CD and suprachoroidal hemorrhage (hemorrhagic choroidal detachment). Serous CD demonstrates echolucent areas beneath the choroid, while suprachoroidal hemorrhage shows dense suprachoroidal opacities (Fig. 6C, D).31 CD with RD can be differentiated from RD with subretinal hemorrhage by the double-peak spike corresponding to the CD on A-scan (Fig. 6E, F).

RETINALTEAR

Men have a significantly higher risk of developing retinal tears after PVD.32 Retinal tears are associated with VH in 35% of cases. Ultrasound is very accurate at detecting small retinal tears, with a sensitivity and specificity of more than 90%.2,3 On ultrasound, retinal tears are seen as a focal elevation of the retina that usually has an adherent strand of vitreous, with high reflectivity in the retinal portion, very little movement, and lower reflectivity in the vitreous strand (Fig. 7A). The vitreous strand will disappear with reductions in gain, while the retina will remain visible at low gain.

Associated Retinal Detachment

A focal, shallow RD may be found close to the retinal tear, and care should be taken to avoid overlooking this finding. In presence of a concomitant RD, retinal tears are usually located within 2 hours of the area of greatest retinal elevation.7

Giant Retinal Tear

A giant retinal tear is defined as a tear that spans more than one quadrant (3 clock-hours) of the

retina. Giant retinal tears should be suspected whenever there is a area of lucency in the retina spanning more than one quadrant of the retina.4 A giant retinal tear will appear as two membranes attached to the optic disc on ultrasound, with the echo discontinuous with the optic disc representing the inverted posterior flap of the tear, and the second echo representing the detached retina (Fig. 7B). The ultrasonographic findings in giant retinal tears can be extremely varied, as they usually occur in combination with other traumatic changes to the posterior segment (see the article by Dadgostar and colleagues, elsewhere in this issue.).

Differential Diagnosis

The main differential diagnosis of a retinal tear in VH is an area of neovascularization.3 Areas of neovascularization also extend from the retina to the posterior vitreous face. They are differentiated from retinal tears by their location, usually occurring in the posterior pole; lack of discontinuity of the retinal echo; and acoustic enhancement at the site of attachment to the posterior vitreous face.

RETINAL PIGMENT EPITHELIUM DETACHMENT

Retinal pigment epithelium detachment (PED) is observed in several chorioretinal diseases that are inflammatory, degenerative, ischemic, or idiopathic in origin. Pigment epithelial detachments occur most commonly as a result of age-related thickening of Bruch’s membrane secondary to lipid deposits, which can lead to photoreceptor dysfunction and loss of the original architec- ture.33–36 A common complication of PED is RPE