To illustrate the distinguishing findings of choroidal hemorrhage on enhanced depth imaging optical coherence tomography.
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.
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.
An elderly patient with blurred vision presented with a pigmented choroidal lesion with slight hyperfluorescence on angiography, suggestive of choroidal melanoma. Enhanced depth imaging optical coherence tomography disclosed an irregular, “scalloped” anterior surface of the choroidal mass with shallow lateral wings, consistent with hemorrhage. Upon follow-up, the hemorrhage completely resolved.
Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
Reprint requests: Carol L. Shields, MD, Ocular Oncology Service, Suite 1440, Wills Eye Institute, 840 Walnut Street, Philadelphia, PA 19107; e-mail: email@example.com
Paper presented as a case at the Atlantic Coast Retina Club, Baltimore, MD, January 18, 2013 (S.J.N.).
Supported by Eye Tumor Research Foundation, Philadelphia, PA (C.L.S.).
None of the authors have any conflicting interests to disclose.
C. L. Shields has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.