title: Ciliary body and choroidal pseudomelanoma from ultrasonographic imaging of hypermature cataract in 20 cases.
abstract: OBJECTIVE
  To describe a series of 20 patients with opaque media, referred with uveal melanoma, but subsequently found to have pseudomelanoma from oblique imaging of hypermature cataract on ultrasonography.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Twenty patients.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Ultrasound imaging.
  
  
  RESULTS
  All eyes had opaque media from hypermature cataract with no view of the fundus. All were referred because of suspected uveal melanoma, based on ultrasonographic imaging. The echogenic mass appeared to be in the ciliary body (n = 17) or choroid (n = 3). The median patient age was 54 years (range, 17-86 years). Most patients were white (n = 13) or black (n = 4). There was a history of eye trauma (n = 3) and ocular surgery (n = 1). Visual acuity was light perception to hand movements (n = 18) and 20/50 to 20/100 (n = 2). The cataract was in an anatomic position (n = 18) or subluxated (n = 2). On B-scan ultrasonography, the mass was dome-shaped (n = 10) or elliptical (n = 10), displayed an acoustically hollow center with a dense rim (n = 20), and was located in the ciliary body (n = 17) or choroid (n = 3). The mean thickness was 7.2 mm and the mean base was 9.3 mm. Features suggestive of cataract rather than melanoma included a lack of contiguity with the uvea (n = 20) on videoimaging using standard ultrasonography and ultrasound biomicroscopy, a lack of a transillumination shadow, and a lack of a sentinel vessel. For those in the ciliary body region, an additional feature was the ultrasonographic presence of mass in all 4 quadrants (n = 17), representing oblique imaging of the lens equator. For those in the choroid region, the pseudomelanoma shifted when the patient was imaged in a reclined compared with an upright position. After cataract surgery, the lack of melanoma was confirmed.
  
  
  CONCLUSIONS
  Dense cataract can preclude a fundus view, necessitating ultrasonography for imaging the posterior segment of the eye. Ultrasonographic confusion with a ciliary body and choroidal melanoma can occur because the dome-shaped cataract can simulate a dome-shaped melanoma.
authors.affiliation: Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: carol.shields@shieldsoncology.com.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.affiliation: Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Marco
authors.initials: M
authors.lastname: Pellegrini
authors.affiliation: Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Brad E
authors.initials: BE
authors.lastname: Kligman
authors.affiliation: Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Carlos
authors.initials: C
authors.lastname: Bianciotto
authors.affiliation: Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000000981:diagnostic imaging* / Q000473:pathology; D002830:Choroid Neoplasms / Q000000981:diagnostic imaging*; D002924:Ciliary Body / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging*; D033401:Microscopy, Acoustic; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D014604:Uveal Neoplasms / Q000000981:diagnostic imaging*; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult