COTW 11/27/22 67 Year old male presents with 1 day of painless vision loss.

A 67 year old male history of HTN, HLD, and a 50 pack year smoking history presents for evaluation of 24 hours of left sided painless vision loss. His exam is notable for 20/100 vision in the left eye and 20/20 vision on the right. The remainder of his neurologic exam is unremarkable. As part of your workup for his vision loss you perform an ultrasound of the eye and see below.

Hyperechoic spot with subtle shaddowing within the optic nerve sheath.

Above is what is called a spot sign. It is seen when CRAO occurs secondary to atheromatous plaque rupture and embolism. What you are seeing on the ultrasound is the calcified piece of that embolus. Note that this is not the definitive diagnostic modality by any means, but if you see it definitely give yourself a hearty pat on the back.