Coughing-Induced Suprachoroidal Hemorrhage Simulating Melanoma in Two Cases

Marous, Charlotte L.; Sioufi, Kareem; Shields, Carol L.; Mashayekhi, Arman; Shields, Jerry A.

doi:10.1097/icb.0000000000000502

Cited by 17 publications

(15 citation statements)

References 16 publications

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“…[5] The patient not only presented with ocular FFA, fundus fluorescein angiography; ICG, indocyanine green angiography; OCT, optical coherence tomography pain, which is usually seen associated with posterior scleritis or granuloma, but also with features suggestive of SCH, which caused a diagnostic dilemma. [1] The fundus lesion of a brown elevated mass mimicked melanoma, hemangioma, and granuloma, but the features of melanoma-like orange pigments were absent.…”

Section: Discussionmentioning

confidence: 99%

“…This feature of SCH has already been described. [1,6] The presence of choroidal folds over the lesion with background normal fluorescence in FA and choroidal folds over an optically empty elevated lesion in OCT is a feature of SCH. [6,7] A choroidal hemangioma would show high surface and internal reflectivity in B scan and bright hyperfluorescence on FFA.…”

Section: Discussionmentioning

confidence: 99%

“…A few cases of SCH following Valsalva maneuver and delayed postoperative hemorrhage have been reported. [1] A localized spontaneous SCH can cause diagnostic dilemma by presenting as a choroidal mass. Multimodal imaging including fluorescein angiography (FA), indocyanine green angiography (ICG), ultrasound B scan, and optical coherence tomography (OCT) help to differentiate various choroidal mass lesions like melanoma, choroidal granuloma, choroidal hemangioma, posterior scleritis, and suprachoroidal hemorrhage (SCH).…”

Section: Spontaneous Suprachoroidal Hemorrhage (Sch) Is a Rare Occurrmentioning

confidence: 99%

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Multimodal Imaging in a Case of Localized Suprachoroidal Hemorrhage

Oli¹,

Balakrishnan²

2020

JOVR

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Purpose: To report a case of localized suprachoroidal hemorrhage presenting as a choroidal mass. Case Report: A 66-year-old lady presented with sudden onset pain in the right eye, one week following uneventful cataract surgery. The best corrected visual acuity (BCVA) was 20/160 and fundus examination showed a brown elevated choroidal mass temporal to the fovea in the right eye with normal retina and retinal vessels over it. The differential diagnoses considered were choroidal granuloma, melanoma, choroidal hemangioma, posterior scleritis, and localized suprachoroidal haemorrhage (SCH). Fluorescein angiography (FA) and indocyanine green (ICG) angiography were unremarkable except for mild disc leakage; B-scan showed a choroidal mass with high surface reflectivity and low internal reflectivity, and OCT showed an elevation of retinochoroidal complex with hyporeflective mass in the outer choroid with choroidal folds suggestive of SCH. Her systemic evaluation showed raised ESR and consolidation in the upper lobe of the right lung. The patient did not take any additional treatment for her eye and the lesion regressed and visual acuity improved to 20/30 in one month. Conclusion: Delayed spontaneous suprachoroidal hemorrhage can present as a choroidal mass. Multimodal imaging helps to differentiate it from other sight-threatening and life-threatening ocular diseases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Spontaneous Suprachoroidal Hemorrhage (Sch) Is a Rare Occurrmentioning

confidence: 99%

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Multimodal Imaging in a Case of Localized Suprachoroidal Hemorrhage

Oli¹,

Balakrishnan²

2020

JOVR

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“…Marous et al [17] have also described 2 cases of coughing-induced suprachoroidal hemorrhage simulating melanoma. However, development of suprachoroidal hemorrhage in a patient with ITP has rarely been recognized.…”

Section: Discussionmentioning

confidence: 99%

Suprachoroidal Hemorrhage Simulating Melanoma in Idiopathic Thrombocytopenic Purpura

2018

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Background: We report a case of suprachoroidal hemorrhage simulating choroidal melanoma in a patient with idiopathic thrombocytopenic purpura (ITP). Methods: Case report. Results: A 79-year-old white male with a history of lung adenocarcinoma, ITP, and mild anemia noted blurred vision with photopsia and floaters in the right eye (OD) that worsened over 2 months. He was found to have a pigmented choroidal mass and was referred for evaluation of possible choroidal melanoma. Visual acuity was 20/30 in the affected right eye and 20/25 in the left eye (OS). There was mild vitreous hemorrhage and 2 pigmented peripheral choroidal tumors in the temporal and nasal fundus OD. B-scan ultrasonography confirmed 2 acoustically hollow tumors, and transillumination demonstrated no shadowing. Optical coherence tomography over the lesions revealed choroidal elevation with suprachoroidal scalloped surface. Fluorescein and indocyanine green angiography revealed normal choroidal fluorescence and cyanescence with no “double circulation” of melanoma and no dye blockage, suggesting a suprachoroidal location. These findings were suggestive of suprachoroidal hemorrhage rather than melanoma. The patient was managed conservatively, and the hemorrhages demonstrated spontaneous resolution. Conclusion: Ocular manifestations of ITP are uncommon. Rarely, spontaneous suprachoroidal hemorrhage simulating melanoma can occur. A thorough clinical evaluation with multimodal imaging is critical to establishing the appropriate diagnosis.

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“…Similarly, the indocyanine green angiogram is typically silent in SCH, whereas in choroidal tumors, it exhibits abnormal internal choroidal vessels. 10 Other imaging modalities that can detect SCH but are not routinely performed are computed tomography and magnetic resonance imaging. 11,12…”

Section: Practical Retinamentioning

confidence: 99%

Suprachoroidal Hemorrhage: Risk Factors and Diagnostic and Treatment Options

Mantopoulos¹,

Fine²

2019

Ophthalmic Surg Lasers Imaging Retina

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from the Geisel School of Medicine at Dartmouth and the Rutgers Robert Wood Johnson Medical School, respectively, discuss the risk factors and diagnostic and treatment options for managing suprachoroidal hemorrhage. We are all aware that there is great discussion and wide variability in thinking among our colleagues regarding approaches to diagnose and manage suprachoroidal hemorrhage. Common discussion includes definitive differentiation of tumors, congenital retinal pigment epithelial hypertrophy, and suprachoroidal hemorrhage. Acute intra-and perioperative management of this condition is frequently debated. Additionally, discussion frequently takes place regarding early versus delayed drainage. Drs. Mantopoulos and Fine tackle this topic in a concise and logical manner. They will provide a thorough review of the literature and provide opinions based on their clinical experience and strength of the evidence in the literature. I am certain that their insights will be very valuable for optimizing outcomes in patients with this unfortunate condition.

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Coughing-Induced Suprachoroidal Hemorrhage Simulating Melanoma in Two Cases

Abstract: Coughing-induced suprachoroidal hemorrhage can simulate melanoma. Clinical and imaging features can assist in diagnosis. The hemorrhage generally resolves within few months.

Cited by 17 publications

References 16 publications

Multimodal Imaging in a Case of Localized Suprachoroidal Hemorrhage

Multimodal Imaging in a Case of Localized Suprachoroidal Hemorrhage

Suprachoroidal Hemorrhage Simulating Melanoma in Idiopathic Thrombocytopenic Purpura

Suprachoroidal Hemorrhage: Risk Factors and Diagnostic and Treatment Options

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