title: Evanescent vaso-occlusive choroidal pseudo-tumor with acute painful onset: a presumed vortex vein occlusion.
abstract: OBJECTIVE
  The aim of our study was to describe the clinical presentation of an unusual evanescent, exudative, choroidal pseudo-tumor with acute painful onset, and propose a pathogenesis.
  
  
  METHODS
  We carried out a retrospective, observational study using the case series of three patients presenting with an evanescent, exudative, choroidal pseudo-tumor with acute painful onset. Ultra-widefield fluorescein and indocyanine green angiography (ICGA) using the Heidelberg Retina Angiograph and the Staurenghi 230 SLO Retina Lens were used to propose a pathogenesis of this unusual entity.
  
  
  RESULTS
  In all three cases, acute ocular pain led to discovery of an exudative, partially hemorrhagic choroidal mass (thickness 2.4 mm-4.1 mm on ultrasound) that quickly regressed within weeks. In the subacute phase, all patients showed choroidal circulation abnormalities on dynamic wide-field ICGA in the affected quadrant, with delayed arterio-venous filling in two patients, and a poorly-defined vortex vein in the third. The choroidal circulation abnormalities resolved within 8-12 weeks, simultaneously with the spontaneous resolution of the choroidal pseudo-tumor. The findings evoked a self-resolving vortex vein occlusion in the corresponding quadrants with acute, painful choroidal exudation.
  
  
  CONCLUSIONS
  An evanescent, exudative, hemorragic choroidal pseudo-tumor with acute painful onset may be caused by a vortex vein occlusion. Future patients need to be studied with ICGA in the acute phase to confirm this hypothesis.
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland, irmela.mantel@fa2.ch.
authors.forename: Irmela
authors.initials: I
authors.lastname: Mantel
authors.forename: Ann
authors.initials: A
authors.lastname: Schalenbourg
authors.forename: Leonidas
authors.initials: L
authors.lastname: Zografos
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001775:Blood Circulation; D002829:Choroid / Q000098:blood supply*; D002832:Choroid Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D002830:Choroid Neoplasms / Q000175:diagnosis / Q000209:etiology*; D004396:Coloring Agents; D005122:Exudates and Transudates; D058447:Eye Pain / Q000175:diagnosis / Q000209:etiology*; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green