Presentation
Reduction in visual acuity of right eye
Patient Data
Patient was under ophthalmology follow up for the macula subretinal fibrosis possibility due to idiopathic polypoidal choroidal vasculopathy. Incidental finding on the routine fundoscopy of right eye : choroidal mass more than 10 disc diameter extending temporal to macula region with subretinal red hue temporally, lipofuscin inferiorly and minimal subretinal fluid superiorly.
Followed by ultrasound B scan: Dome shaped choroidal mass measuring 3.01 mm (w), 7.13mm (h), anterior hyperreflective border, internal acoustic hollowness, no collar stud appearance, no excavation.
Both eye globes are normal in configuration. No eye proptosis.
No abnormal enhancing lesion seen at the sclera-choroid-retina of both eyes. No subretinal fluid. No abnormal calcification.
No obvious lesion seen within the vitreous segment of both eyes, specifically the right eye.
No retrobulbar lesion.
Small retinal/choroidal lesion may not be visualized in CT scan, suggest for MRI orbit in view of positive ultrasound and fundoscopy examination of choroidal mass.
Focal nodular choroidal lesion at posterolateral aspect of right orbit. The lesion is intermediate signal on T1WI, low signal intensity on T2WI , high signal on FLAIR sequence and homogenously enhanced post contrast administration.
No extra-ocular extension.
The left eye otherwise is normal.
Brain is unremarkable. No signs of Sturge Weber syndrome.
Case Discussion
This case depicts the limitation of CT scan for assessing choroidal/retinal lesion if the lesion is small and without extraocular extension.
The top differential diagnoses to consider for this case include choroidal hemangioma, amelanocytic choroidal melanoma , choroidal lymphoma and choroidal granuloma.
FLAIR sequence is a sensitive MRI sequence to detect any subtle choroidal/retinal lesion after suppression of high T2 fluid signal intensity.