title: The role of orbital ultrasonography in distinguishing papilledema from pseudopapilledema.
abstract: OBJECTIVE
  To determine the sensitivity and specificity of orbital ultrasonography in distinguishing papilledema from pseudopapilledema in adult patients.
  
  
  METHODS
  The records of all adult patients referred to the neuro-ophthalmology service who underwent orbital ultrasonography for the evaluation of suspected papilledema were reviewed. The details of history, ophthalmologic examination, and results of ancillary testing including orbital ultrasonography, MRI, and lumbar puncture were recorded. Results of orbital ultrasonography were correlated with the final diagnosis of papilledema or pseudopapilledema on the basis of the clinical impression of the neuro-ophthalmologist. Ultrasound was considered positive when the optic nerve sheath diameter was ≥3.3 mm along with a positive 30° test.
  
  
  RESULTS
  The sensitivity of orbital ultrasonography for detection of papilledema was 90% (CI: 80.2-99.3%) and the specificity in detecting pseudopapilledema was 79% (CI: 67.7-90.7%).
  
  
  CONCLUSIONS
  Orbital ultrasonography is a rapid and noninvasive test that is highly sensitive, but less specific in differentiating papilledema from pseudopapilledema in adult patients, and can be useful in guiding further management of patients in whom the diagnosis is initially uncertain.
authors.affiliation: Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.
authors.forename: S B
authors.initials: SB
authors.lastname: Carter
authors.affiliation: Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Pistilli
authors.affiliation: Division of Neuro-Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: K G
authors.initials: KG
authors.lastname: Livingston
authors.affiliation: Division of Neuro-Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Gold
authors.affiliation: Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Volpe
authors.affiliation: Division of Neuro-Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Shindler
authors.affiliation: Division of Neuro-Ophthalmology, Hospital of University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: G T
authors.initials: GT
authors.lastname: Liu
authors.affiliation: Division of Neuro-Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Tamhankar
mesh_terms: D000328:Adult; D015785:Eye Diseases, Hereditary / Q000000981:diagnostic imaging*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000000981:diagnostic imaging*; D009901:Optic Nerve Diseases / Q000000981:diagnostic imaging*; D009915:Orbit / Q000000981:diagnostic imaging*; D010211:Papilledema / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D055815:Young Adult