[Choroidal folds as a diagnostic indication for a posterior mass of unknown etiology]

A 59-year-old woman presented with a four-month history of progressive visual loss and floaters in her left eye. Her medical history included hypothyroidism, psoriasis, and type 2 diabetes. Fundus examination revealed choroidal folds, an amelanotic lesion temporal to the fovea, and an exudative retinal detachment. Optical coherence tomography (OCT) demonstrated a choroidal mass without subretinal fluid, while indocyanine green angiography (ICGA) showed a hypocyanescent lesion with no intrinsic vascularity. B-scan ultrasonography revealed an inhomogeneous choroidal mass with retrobulbar fluid (positive T-sign). Blood tests revealed elevated C-reactive protein (CRP) and liver enzymes levels, together with positive antinuclear antibodies (ANA), while the chest X-ray was normal. The overall clinical and imaging findings were consistent with nodular granulomatous scleritis. Choroidal melanoma, uveal lymphoma, primary vitreoretinal lymphoma, and choroidal hemangioma were excluded based on their imaging characteristics. Treatment with systemic corticosteroids resulted in rapid visual improvement and complete resolution of the lesion. This case demonstrates how inflammatory choroidal lesions can mimic intraocular tumors. Recognizing characteristic multimodal imaging features (choroidal folds, preserved choroidal vasculature on ICGA, positive T-sign on ultrasonography) can enable a confident diagnosis without biopsy, avoiding unnecessary treatment and delays in cancer diagnosis.