PFV is a rare congenital orbital malformation in which there is failure of the hyaloid artery to regress causing a persistent vasculature within the vitreous portion of the eye. Patients present with leukocoria that can be unilateral or bilateral. The most concerning differential diagnosis is retinoblastoma. We present three case studies referred for evaluation to exclude retinoblastoma in which MFI assisted in making the diagnosis of PFV. Imaging was perfomed with a high frequency linear array transducer and established preset in accordance with FDA guidelines. When characterizing orbital masses, early and accurate diagnosis is crucial to the patient’s prognosis. Ultrasound can be a superior method due to its ability to visualize superficial structures and detect slow velocity blood flow. While CD and SD are able to determine direction and velocity of flow, MFI improves the sensitivity and ability to display microvascularities. Case 1 Three-month-old male with right eye leukocoria. Ultrasound demonstrated smaller right than left globe. A triangular retrolental amorphous and heterogeneous soft tissue mass was present. A mass with fibrovascular stalk containing a persistent hyaloid artery was observed with layering debris. Left orbit was normal. Findings consistent with right PFV. Case 2 Six-week-old female with left eye leukocoria. Ultrasound demonstrated a normal right globe. The left globe had a hyperechogenic triangular mass extending from the posterior margin of the lens to the optic nerve. A persistent hyaloid artery was noted. The posterior margin of the lens was irregular. A small amount of subretinal fluid over lied the optic nerve. Findings consistent with left PFV. Case 3 Newborn male with microphthalmia and possible cataractous lens. Ultrasound demonstrated right globe with lens intact, anechoic and normally located. A hyperechogenic mass with ill-defined borders extends from the posterior aspect of the lens to the retina along the central aspect of the globe. No calcifications were observed. Blood flow noted within a persistent hyaloid artery. The triangular portion of the mass attached to the lens also demonstrated increased microvascularity. Left globe with intact lens which was anechoic and normally located. Evaluation of the left posterior chamber demonstrates a similar-appearing mass with a persistent hyaloid artery. Findings consistent with bilateral PFV. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Riemann Monique, Bisbing Brecken, Goncalves Luis, Ramasubramanian Aparna

Keywords: orbital, persistent fetal vasculature, micro flow imaging