Roth spot

Roth spots

Other names: Litten sign
Roth spot on the retina of the left eye in infective endocarditis
Specialty| Ophthalmology, cardiology, general medicine
Symptoms| Red spots with white or pale centres[1]
Causes| Conditions that predispose to endothelial damage of retinal capillaries[1]
Diagnostic method| Fundoscopy, visual appearance[1]
Frequency| 80% of people with subacute bacterial endocarditis[1]

Roth spots, also known as Litten spots are non-specific red spots with white or pale centres, seen on the retina.[1] Although traditionally associated with infective endocarditis, they can occur in a number of other conditions including hypertension, diabetes, collagen vascular disease, extreme hypoxia, leukemia and HIV.[2]

The spots are typically observed via fundoscopy (using an ophthalmoscope to view inside the eye) or slit lamp exam.[1][2] They can be composed of coagulated fibrin including platelets, focal ischaemia, inflammatory infiltrate, infectious organisms, or neoplastic cells.[3]

Around 80% of people with subacute bacterial endocarditis have Roth spots.[1] Red and white retinal spots were first observed in 1872 by Swiss physician Moritz Roth, and named "Roth spots" six years later by Moritz Litten.[4]

## Contents

* 1 Cause
* 2 Associated conditions
* 3 Prevalence
* 4 See also
* 5 References

## Cause[edit | edit source]

Roth's spots occur in conditions that predispose to endothelial damage of retinal capillaries, that is when there is dysfunction and disruption of the endothelium of retinal capillaries.[1] Looking through the microscope reveals lesions with white centers made mainly of fibrin, depicting a fibrin-platelet plug at the site of vessel damage.[1]

## Associated conditions[edit | edit source]

Conditions associated with Roth's spots include:[1][5]

* Infective endocarditis
* Anaemia/thrombocytopenia
* Collagen vascular disease
* Leukemia
* Hypertensive retinopathy
* Diabetic retinopathy
* Pre-eclampsia
* Human Immunodeficiency Virus (HIV)
* Extreme hypoxia
* Shaken-baby syndrome

and also:[2]

* Candida albicans infection
* vascular diseases
* kala azar

## Prevalence[edit | edit source]

Roth's spots occur in only 5% of people with infective endocarditis.[6] Litten, however reported a figure of 80%.[1]

## See also[edit | edit source]

* Osler's nodes
* Janeway lesion
* Splinter haemorrhage

## References[edit | edit source]

1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Ruddy, Stephanie M.; Bergstrom, Reece; Tivakaran, Vijai S. (18 July 2022). "Roth Spots". StatPearls. StatPearls Publishing. PMID 29494053. Archived from the original on 3 November 2022. Retrieved 3 November 2022.
2. ↑ 2.0 2.1 2.2 Blumenthal, Eytan Z.; Ehud, Zamir (9 March 1999). "Roth's Spots". Circulation. 99 (9): 1271. doi:10.1161/01.CIR.99.9.1271. PMID 10069798.
3. ↑ Lepore, Frederick (1995). "Roth's Spots in Leukemic Retinopathy". New England Journal of Medicine. 332 (5): 335. doi:10.1056/NEJM199502023320515. PMID 7816078.
4. ↑ Yale, Steven H.; Tekiner, Halil; Mazza, Joseph J.; Yale, Eileen S.; Yale, Ryan C. (2021). "3. Endocarditis". Cardiovascular Eponymic Signs: Diagnostic Skills Applied During the Physical Examination. Switzerland: Springer. pp. 78–82. ISBN 978-3-030-67595-0. Archived from the original on 2023-07-01. Retrieved 2023-05-28.
5. ↑ "What is a roth spot?". Stanford Medicine 25. 24 March 2016. Archived from the original on 3 November 2022. Retrieved 11 August 2019.
6. ↑ "What are the classic signs of infective endocarditis (IE)?". www.medscape.com. Archived from the original on 3 November 2022. Retrieved 12 August 2019.

* v
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* e

Signs and symptoms and relating to the eye

Adnexa|

* lacrimal: Schirmer's test

* eyelid: Abadie's sign of exophthalmic goiter
* Boston's sign
* Dalrymple's sign
* Stellwag's sign

Globe|

* pupil: Argyll Robertson pupils
* Adie pupil
* Marcus Gunn pupil

* cornea: Fleischer ring
* Kayser–Fleischer ring
* Hudson–Stahli line

* iris: Brushfield spots
* Lisch nodule

* conjunctiva: Bitot's spots
* Arlt's line

* retina: Hollenhorst plaque
* Roth's spot
* Fuchs spot

* others: Alexander's law
* Hirschberg test
* Siegrist streaks

* v
* t
* e

Signs and symptoms relating to the circulatory system

Chest pain|

* Referred pain
* Angina
* Levine's sign

Auscultation|

* Heart sounds
* Split S2
* S3
* S4
* Gallop rhythm
* Heart murmur
* Systolic
* Functional murmur
* Still's murmur
* Diastolic
* Pulmonary insufficiency
* Graham Steell murmur
* Continuous
* Carey Coombs murmur
* Mitral insufficiency
* Presystolic murmur
* Pericardial friction rub
* Heart click
* Bruit
* carotid

Pulse|

* Tachycardia
* Bradycardia
* Pulsus paradoxus
* doubled
* Pulsus bisferiens
* Pulsus bigeminus
* Pulsus alternans

Other|

* Palpitations
* Apex beat
* Cœur en sabot
* Jugular venous pressure
* Cannon A waves
* Hyperaemia

Shock|

* Cardiogenic
* Obstructive
* Hypovolemic
* Distributive
* See further Template:Shock

Cardiovascular disease|

| Aortic insufficiency|

* Collapsing pulse
* De Musset's sign
* Duroziez's sign
* Müller's sign
* Austin Flint murmur
* Mayne's sign

|

Other endocardium|

* endocarditis: Roth's spot
* Janeway lesion/Osler's node
* Bracht–Wachter bodies

Pericardium|

* Cardiac tamponade/Pericardial effusion: Beck's triad
* Ewart's sign

Other|

* rheumatic fever:
* Anitschkow cell
* Aschoff body
* EKG
* J wave
* Gallavardin phenomenon

Vascular disease|

| Arterial|

* aortic aneurysm
* Cardarelli's sign
* Oliver's sign
* pulmonary embolism
* Right heart strain
* radial artery sufficiency
* Allen's test
* pseudohypertension
* thrombus
* Lines of Zahn
* Adson's sign
* arteriovenous fistula
* Nicoladoni sign

|

Venous|

* Friedreich's sign
* Caput medusae
* Kussmaul's sign
* Trendelenburg test
* superior vena cava syndrome
* Pemberton's sign

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