To describe a case of ciliochoroidal
melanoma with massive spontaneous hemorrhagic
retinal and
choroidal detachment that presented a diagnostic challenge because of poor fundus visualization and atypical imaging features.
METHODS: Case report.
RESULTS: A 71-year-old white man on
apixaban for
atrial fibrillation presented with sudden onset of
pain and vision loss in the left eye. The patient was found to have total hemorrhagic
retinal detachment and was referred for our opinion. On examination, visual acuity was 20/25 in the right eye and light perception in the left eye. Intraocular pressures were 10 mmHg in the right eye and 21 mmHg in the left eye. The unaffected right eye demonstrated only macular
retinal pigment epithelial alterations. Evaluation of the left eye revealed dilated episcleral sentinel vessels superonasally, shallow anterior chamber, and total hemorrhagic
retinal and
choroidal detachment to the back of the crystalline lens. There was no view of the choroid. Transillumination demonstrated diffuse blockage of light from blood and no specific shadow. B-scan ultrasonography revealed total
retinal and
choroidal detachment with dense echoes of blood under the retina and in the
suprachoroidal space with elevation of 12 mm and no definite mass or spontaneous vascular pulsations. Magnetic resonance imaging revealed diffuse high signals within the globe on T1-weighted images with no specific mass. On
gadolinium enhancement, a localized enhancing area temporally of 12-mm thickness and a localized nonenhanced area nasally of 11-mm thickness was noted. Both areas showed low signal on T2-weighted images. Despite atypical features, suspicion for underlying ciliochoroidal
melanoma and poor visual prognosis lead to enucleation. Histopathology confirmed an extensively necrotic, mushroom-shaped ciliochoroidal
melanoma with total hemorrhagic
retinal and
choroidal detachment.
CONCLUSION: