The “guitar pick” sign: a novel sign of retrobulbar hemorrhage

Abstract

Retrobulbar hemorrhage is a rare complication of blunt ocular trauma. Without prompt intervention, permanent reduction in visual acuity can develop in as little as 90 minutes. We report a novel bedside ultrasound finding of conical deformation of the posterior ocular globe: the ''guitar pick'' sign. In our elderly patient, the ocular globe shape normalized post-lateral canthotomy and inferior cantholysis. Identifying this sonographic finding may add to the clinical examination when deciding whether to perform decompression. RÉ SUMÉUne hé morragie ré trobulbaire est une complication rare d'un traumatisme oculaire pé né trant. Si l'on n'intervient pas rapidement, une ré duction permanente de l'acuité visuelle peut se produire en aussi peu que 90 minutes. Nous pré sentons un nouveau cas d'é chographie au chevet du patient pré sentant une dé formation conique du segment posté rieur du globe oculaire que nous avons baptisé le signe du « pic de guitare ». Chez notre sujet â gé , le globe oculaire a repris sa forme normale aprè s une canthotomie laté rale et une cantholyse infé rieure. L'utilisation de l'é chographie pour identifier ce signe peut constituer un outil complé mentaire à l'examen clinique visant à dé terminer l'indication de dé compression.

Early Detection of Traumatic Retrobulbar Hemorrhage Using Bedside Ocular Ultrasound

“…Two were examples of RBH with a single hypoechoic area posterior to the globe, but there were no case details and neither was confirmed by CT (7,11). The third case involved severely elevated intraocular pressure and very latestage conical deformation of the globe, but did not demonstrate a classic hypoechoic collection on ultrasound (12). Our sonographic image of RBH demonstrates a thin anechoic stripe just posterior to the globe with retrobulbar hypoechoic collections and confirmatory CT.…”

“…If our case had increased orbital pressure treated with canthotomy and cantholysis, the fluid collections may have changed in size or depth. One case report captured dramatic normalization of globe contour postcanthotomy using ultrasound (12). Using these sonographic findings adds to the clinical examination to rapidly detect early RBH and expedite emergent decompression.…”

Traumatic and Iatrogenic Retrobulbar Hemorrhage: An 8-Patient Series

“…18 If needed, ultrasonography helps in the diagnosis by detecting the typical bulbar deformation, the "guitar pick" sign. 19 Confirmation of this diagnosis requires CT. However, every effort should be made to avoid a delay in treatment if RBH is suspected.…”

New Perspectives for Modern Trauma Management – Lessons Learned from 25 Years FAST and 15 Years E-FAST

“…The search for retroperitoneal bleeding [51], free air [52], organ lesions with and without CEUS [38], as well as the determination of the volume status [53] should be integrated into stage C (circulation). In stage D (disability), it is possible to sonographically visualize an early stage retroorbital hematoma, which can lead to blindness within one hour if untreated [54], as well as the signs of increased intracranial pressure [55]. Stage E (exposure) deals with the diagnosis of fractures of the extremities [56], facial bones or skull fractures [57] and joint dislocations [58].…”