[Spontaneous subretinal isolated hematomas or associated with macular degeneration: a retrospective review of 95 cases].
BACKGROUND
Diagnosis of choroidal hematoma, either spontaneous or associated with age-related macular degeneration, is clinical. In some cases of expansive or posterior lesion, hematoma may be misdiagnosed as a tumor. MRI and color Doppler imaging (CDI) are important in ruling out uveal melanoma in these cases.


METHODS
We reviewed the clinical, MRI, and ultrasonographic characteristics of 95 patients sent to the Curie Institute for suspected uveal melanoma between 1998 and 2006, whose final diagnosis was a choroidal hematoma. Imaging differences with melanomas are discussed.


RESULTS
A total of 95 patients with a diagnosis of hematoma were seen; the age varied from 54 to 92 years with a median age of 77 years; there was a history of macular degeneration in 27 cases and 11 patients were taking an anticoagulant. Intravitreous hemorrhage was noted in 18 cases and the lesion was located in the posterior pole in 28 cases. The thickness of the lesions measured by B scan ultrasonography varied between 1 and 7.8mm, with a mean thickness of 2.86mm. MRI was performed in 27 cases and CDI in ten cases. On CDI, hematomas appeared as linear or regular bulging lesions with no intralesional blood flow. On MRI, hematomas appeared as a high-intensity signal on T1-weighted images, heterogeneous on T2-weigted images in relation to the progression of the clot, but no contrast enhancement was noted inside the lesion. Follow-up examinations showed the progressive involvement of the clot and delayed decreasing size of the lesion.


CONCLUSIONS
The diagnosis of choroidal hematoma is usually made by fundus examination. In some posterior locations with pseudo-tumoral appearance, CDI and MRI are useful to rule out a uveal tumor.
Institut Curie, Paris. laurence.desjardins@curie.net
L
L
Desjardins
S
S
Gerber
O Berges
M T
MT
IbaZizen
C Levy
CL
Gabriel
L Lumbroso
LL
LeRouic
H
H
Brisse
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D002832:Choroid Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D002830:Choroid Neoplasms / Q000175:diagnosis; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006406:Hematoma / Q000139:chemically induced / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008268:Macular Degeneration / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000175:diagnosis; D008875:Middle Aged; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color; D014823:Vitreous Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology
D000925:Anticoagulants