Clinical manifestation, diagnosis and management of circumscribed choroidal hemangioma

Author: Pilar Llavero Valero (Spain)

Co-authors: Isabel Relimpio, Maria José Morillo Sánchez

Purpose

To describe the clinical features, diagnosis tools, differential diagnosis and management of choroidal hemangioma

Setting/Venue

Methods

Choroidal hemangioma is a benign vascular tumor, commonly situated in the posterior pole. We present a case of a choroidal hemangioma in a 30-years-old patient complaining of blurred vision in his left eye that had been treated as a central serous chorioretinopathy years before. Fundus examination revealed a well-defined, orange-red colored mass situated in the posterior pole involving the fovea. Autofluorescence fundus photographs were obtained and fundus fluorescein angiography was performed. The lesion showed varying degrees of hyperfluorescence in all phases. Indocianin green angiography (ICG) showed the typical “washout phenomenon”. Visual symptoms such as blurred vision, metamorphopsia or visual field defects are normally due to subfoveal fluid, cystoid macular edema or retinal pigment epithelium alteration. Optical Coherence Tomography (OCT) scans revealed a choroidal mass with overlying subretinal fluid. The patient also underwent an angio-OCT that showed a dense vascular network in the choriocapillary layer. B-mode ultrasonography showed a dome-shaped lesion with high internal reflectivity and similar acoustic solidity to the surrounding choroid. This tumor may be similar to other choroidal tumors such as melanoma, especially the amelanotic variant, and choroidal metastasis. Therefore, all these tests are required for a proper diagnosis.

Results

With the diagnosis of symptomatic choroidal hemangioma, the main aim of the treatment was to resolve the subfoveal fluid cause of the diminution of vision in our patient. We decide to performed Double-duration photodynamic therapy (PDT) that produces a selective occlusion of vessels with minimal collateral retinal damage. Three months after the treatment, the lesion had regressed with complete resolution of subretinal fluid and visual acuity of 20/20.

Conlusions

A correct diagnosis of this tumor, based on clinical manifestations and the different tests available, is essential for an early initiation of treatment to preserve and improve the vision.

Financial Disclosure

we have no financial relations