Exudative Retinal Detachment Reveals Metastatic Bladder Cancer

Choroidal metastasis from bladder cancer is very rare, with only a handful of cases cited previously in the literature. We present a case of a patient who presented with a serous retinal detachment and a known history of bladder cancer, which he believed was controlled. Based on the clinical evaluation, his history of bladder cancer, and a retinal consult, a workup was initiated and he was found to have choroidal metastasis from his cancer.

A 77-year-old white man presented with a 1-week history of blurry vision in his left eye and left-sided frontal headaches. His medical history was significant for medically managed hypertension and controlled bladder cancer, which had been treated with transurethral resection of bladder tumor and Bacillus Calmette-Guerin intravesical treatments. The patient had been a smoker for 35 years but had quit 22 years before presentation. A dilated retinal examination found an inferior serous retinal detachment in the left eye, with areas of subretinal folds and fluid encroaching on the macula on both clinical examination and optical coherence tomography imaging. The patient was diagnosed as having an exudative retinal detachment in his left eye, and he was referred for a retinal consult. Subsequent testing with B-scan and fluorescein angiography was suggestive of metastasis as the cause of the exudative detachment. Based on his history of bladder cancer, a chest X-ray was ordered and revealed a left-sided pleural effusion. A chest computed tomography confirmed the left pleural effusion and better visualized its extent. A thoracentesis with cytology supported the diagnosis of metastases from urothelial carcinoma. The patient's bladder cancer was now classified as stage 4, and he died 2 months later.

This case highlights a rare instance of a choroidal metastasis from bladder cancer. As with previous cases, this is a poor prognostic sign for the patient's survival, and he died shortly after the discovery of the lesion. It is important to consider cancer metastasis in the differential diagnosis when presented with a serous retinal detachment and a known cancer diagnosis, even if the patient believes that his cancer is well managed.