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RETINAL Cases & Brief Reports:
doi: 10.1097/ICB.0000000000000048
Case Report

CIRCUMPAPILLARY CHOROIDAL HEMORRHAGE MASQUERADING AS MELANOMA—ENHANCED DEPTH IMAGING OPTICAL COHERENCE TOMOGRAPHY FEATURES

Nickerson, Stephanie J. BA; Shields, Carol L. MD

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Abstract

Purpose:

To illustrate the distinguishing findings of choroidal hemorrhage on enhanced depth imaging optical coherence tomography.

Methods:

Case report.

Results:

An 81-year-old man on a daily aspirin with well-controlled hypertension noted blurred visual acuity and was diagnosed with presumed choroidal melanoma based on the clinical appearance and generalized hyperfluorescence on angiography. Upon referral, visual acuity was 20/100 in the right eye and 20/30 in the otherwise unremarkable left eye. Clinical examination revealed a choroidal mass of velvety-brown color with ill-defined margins, suggestive of hemorrhage. Ultrasonography disclosed a thin echogenic mass of 2.1 mm in thickness. Fluorescein angiography showed a hyperfluorescent mass with overlying hypofluorescent choroidal folds. Enhanced depth imaging optical coherence tomography revealed an irregular anterior contour of the choroid with small folds. Within the deep choroid was a featureless, optically empty region with a scalloped anterior margin pushing the choroid anteriorly and with shallow, scalloped lateral wings. These features were consistent with choroidal hemorrhage. On follow-up at 2 months, complete resolution of hemorrhage was noted.

Conclusion:

Choroidal hemorrhage can resemble choroidal melanoma. Differentiation depends on clinical features and diagnostic testing. Enhanced depth imaging optical coherence tomography shows a scalloped anterior border of the blood in the outer choroid that probably reflects clot contraction.

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