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Cytomegalovirus retinitis


Key points

  • Definition: Cytomegalovirus retinitis (CMVR) is an opportunistic infection that untreated leads to progressive retinal destruction and blindness.

  • Synonym: CMV uveitis

  • Classic clue: AIDS patient presenting with blurred vision, floaters, and blind spots found to have abnormal retinal thickening and enhancement with abnormal signal in the posterior chamber.

  • CMV is a DNA virus from the herpesvirus group, also known as human herpesvirus 5 (HHV-5). ,

  • CMVR is the leading cause of blindness in patients with AIDS.

Imaging

Computed tomography features

  • Computed tomography (CT) may demonstrate irregular uveal thickening and enhancement, retinal detachment, and retinal calcifications. ,

  • May see small areas of high attenuation within the posterior chamber from hemorrhage.

  • Retinal calcifications are better seen on CT.

Magnetic resonance imaging features

  • Magnetic resonance imaging (MRI) demonstrates irregular uveal thickening and enhancement, retinal detachment, and retinal calcifications. ,

  • CMVR characteristically causes retinal edema, hemorrhage, vessel sheathing, and necrosis.

  • Edema: The thickened, edematous retina is demonstrated on all MR sequences, but is probably best appreciated on T1 + Gd with enhancement (see Figure 45-1 , A ).

    FIGURE 45-1 ■, A, Axial T1Gd shows abnormal asymmetric thickening and enhancement of the uvea R > L. Abnormal increased signal involving fluid in the right posterior chamber is probably related to hemorrhage. The abnormal signal involves predominately the dependent two thirds of the posterior chamber. B, Normal retina. C, Fundoscopic view of patient with CMVR. D and E, Fundoscopic images of patient with progressive CMVR. F, “Brush fire” appearance with progressively expanding yellow-white margin surrounding necrotic retina.

  • Hemorrhage: May have different appearance depending on stage. Recent hemorrhage into the posterior chamber may be quite conspicuous on T1 with increased signal.

  • Retinal calcifications are better seen on CT but may occasionally be appreciated as decreased signal on T2.

  • T1 + Gd shows abnormal uveal thickening and enhancement. Increased signal within the posterior chamber.

  • T2 may show retinal detachment with fluid behind the retina. Signal varies depending on the stage of hemorrhage. This retro retinal fluid may be bright on T1 as well but does not enhance with Gd.

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