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Subretinal abscess causing restricted diffusion on magnetic resonance imaging
Crandall Peeler1, Hemant Parmar, Jonathan D Trobe
1Departments of Ophthalmology and Visual Science, Kellogg Eye Center (CP, JDT), Radiology, Division of Neuroradiology (HP), and Neurology (JDT), University of Michigan, Ann Arbor, MI.
Background:
Restricted diffusion of water molecules on diffusion-weighted magnetic resonance imaging most commonly associated with acute stroke, has also been described in brain abscess. It has been reported in only one case of sub-retinal abscess.
Methods:
Review of two cases.
Results:
Two cases of visual loss from subretinal abscess had restricted diffusion in the region of the abscess. In the first case, DWI revealed restricted diffusion in a white mass visible in the posterior retina. In the second case, restricted diffusion was present in an anterior retinal mass invisible by ophthalmoscopy and ultrasound. In combination of restricted diffusion in the cerebrum consistent with septic emboli, these imaging abnormalities allowed earlier treatment that either preserved vision or prevented enucleation.
Insights
Restricted diffusion on MRI can indicate subretinal abscess, a rare cause of vision loss. Early detection through diffusion-weighted imaging (DWI) aids timely treatment and vision preservation.
Area of Science:
- Ophthalmology
- Neuroradiology
- Medical Imaging
Background:
- Restricted diffusion on diffusion-weighted imaging (DWI) is a key indicator of acute stroke and brain abscess.
- Its presence in subretinal abscesses is rarely documented, with only one prior case reported.
Observation:
- This study reviewed two cases of visual loss attributed to subretinal abscess.
- Both cases exhibited restricted diffusion within the retinal abscess on DWI.
Findings:
- The first case showed restricted diffusion in a visible posterior retinal mass.
- The second case revealed restricted diffusion in an anterior retinal mass not detectable by ophthalmoscopy or ultrasound.
- Combined with cerebral restricted diffusion suggesting septic emboli, these findings enabled prompt intervention.
Implications:
- Diffusion-weighted imaging (DWI) can aid in the early diagnosis of subretinal abscess.
- Timely diagnosis and treatment can preserve vision and prevent the need for enucleation.
- This highlights the utility of advanced MRI techniques in diagnosing rare ocular pathologies.
