Circumpapillary choroidal hemorrhage masquerading as melanoma--enhanced depth imaging optical coherence tomography...

To illustrate the distinguishing findings of choroidal hemorrhage on enhanced depth imaging optical coherence tomography.

Case report.

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.

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.