Circumpapillary choroidal hemorrhage masquerading as melanoma--enhanced depth imaging optical coherence tomography features.
OBJECTIVE
To illustrate the distinguishing findings of choroidal hemorrhage on enhanced depth imaging optical coherence tomography.


METHODS
Case report.


RESULTS
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.


CONCLUSIONS
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.
Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
Stephanie J
SJ
Nickerson
Carol L
CL
Shields
D000369:Aged, 80 and over; D002832:Choroid Hemorrhage / Q000175:diagnosis*; D002830:Choroid Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D041623:Tomography, Optical Coherence / Q000379:methods*