Case ReportMULTIMODAL IMAGING OF A CHOROIDAL NEVUS WITH CAVERNS IN THE SETTING OF PACHYCHOROID DISEASECorvi, Federico MD*,†,‡; Corradetti, Giulia MD*,†; Wong, Alice MD†; Pulido, Jose S. MD§; Shields, Carol L. MD¶; Freund, K. Bailey MD**,††; Sarraf, David MD†; Sadda, SriniVas R. MD*,† Author Information *Doheny Eye Institute, Los Angeles, California; †Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California; ‡Department of Biomedical and Clinical Science “Luigi Sacco,” Eye Clinic, Sacco Hospital, University of Milan, Milan, Italy; §Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; ¶Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; **Vitreous Retina Macula Consultants of New York, New York, New York; and ††Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York. Reprint requests: SriniVas R. Sadda, MD, Department of Ophthalmology, Doheny Eye Institute, David Geffen School of Medicine at UCLA, 1355 San Pablo Street, Los Angeles, CA 90033; e-mail: [email protected] K. B. Freund: is a consultant to Genentech (C), Optovue (C), Zeiss (C), Heidelberg Engineering (C), Allergan (C), and Novartis (C). D. Sarraf: Amgen (C, R); Bayer (C, S); Genentech (C, R); Heidelberg (R); Novartis (S); Optovue (C, R, S); Regeneron (R); Topcon (R). S. R. Sadda: Amgen (C), Allergan (C), Genentech-Roche (C), Oxurion (C), Novartis (C), Regeneron (C), Bayer (C), 4DMT (C), Centervue (C, S), Heidelberg (C, F, S), Optos (C, F, S), Carl Zeiss Meditec (F, S), Nidek (S), and Topcon (S). The remaining authors have no financial/conflicting interests to disclose. All authors attest that they meet the current ICMJE criteria for authorship. Retinal Cases & Brief Reports: November 2022 - Volume 16 - Issue 6 - p 670-673 doi: 10.1097/ICB.0000000000001138 Buy Metrics AbstractIn Brief Purpose: To describe the multimodal imaging findings of extensive choroidal caverns within a choroidal nevus in an eye with pachychoroid spectrum disease. Methods: A 69-year-old woman was referred with a known history of branch retinal vein occlusion in the right eye and choroidal nevus in the left eye. Fundus examination of both eyes revealed subretinal yellow deposits, suggestive of pachydrusen. Retinal venous collaterals were noted in the temporal macular of the right eye. A lightly pigmented choroidal lesion with nearly confluent overlying drusen and retinal pigment epithelial alterations, consistent with chronic choroidal nevus, was noted in the macula of the left eye. Results: Optical coherence tomography B-scans revealed thickened choroid (pachychoroid) with subfoveal choroidal thickness of 504 µm and 580 µm with large hyporeflective spaces suggestive of pachyvessels in both eyes. In the region of the choroidal nevus, the choroidal vascular spaces appeared comparatively large and were classified as “caverns” measuring up to 480 µm in diameter. Optical coherence tomography angiography and indocyanine green angiography demonstrated the absence of flow within the caverns. Indocyanine green angiography further illustrated choroidal vascular hyperpermeability with patchy hyperfluorescent areas in both eyes. Wide-field swept-source optical coherence tomography showed mild posterior scleral bowing, a feature occasionally documented with choroidal nevus, and highlighted greater hyporeflectivity and hypertransmission on optical coherence tomography within the caverns compared with the noncavernous choroidal vessels. Conclusion: Choroidal caverns can occur within choroidal nevus in the setting of pachychoroid disease. In this case, we observed an atypical extensive distribution of choroidal caverns within choroidal nevus in the setting of pachychoroid disease.