Bilateral Choroidal Metastases Mimicking Central Serous Chorioretinopathy: A Diagnostic Challenge

We report a case of bilateral choroidal metastases initially misdiagnosed as central serous chorioretinopathy (CSC) in a Hispanic man with no prior oncologic diagnosis. A 72-year-old Hispanic man with no history of ocular disease was referred to our clinic for evaluation of bilateral serous retinal detachments presumed to be CSC. His symptoms, including progressive blurry vision in both eyes, had developed over several months without spontaneous resolution. Multimodal imaging, including fundus autofluorescence (FAF), fluorescein angiography (FA), optical coherence tomography (OCT), and B-scan ultrasonography, revealed bilateral subretinal lesions and atypical features inconsistent with CSC. Given these findings and the patient's report of recent hemoptysis, a systemic workup was pursued, revealing a spiculated mass in the left upper lobe. Biopsy confirmed pulmonary squamous cell carcinoma, staged as T2aN1M1 (Stage 4B). The patient was treated with chemotherapy, thoracic external beam radiotherapy, and bronchodilator therapy; however, upon follow-up, the choroidal lesions and serous retinal detachments worsened, and visual acuity did not improve. This case demonstrates the importance of including choroidal metastases in the differential diagnosis of bilateral serous retinal detachments, especially in older patients or those with systemic red flags. It highlights the crucial role of ophthalmologists in identifying undiagnosed systemic malignancies through fundus examination and multimodal imaging.