Non-invasive imaging of a choroidal macrovessel

Abstract

Purpose To describe novel anatomic findings of an apparent choroidal macrovessel, originally misdiagnosed as a choroidal tumor, using non-invasive imaging tools. Observations Initial ophthalmic examination revealed an elevated hypopigmented choroidal mass in the macular area, with a serpentine track extending temporally to the equator. Enhanced depth imaging optical coherence tomography (EDI-OCT) revealed an optically hollow lesion just outside the choroid-scleral junction (CSJ), indenting the retina and compressing the choroid from the scleral side. Optical coherence tomography angiography (OCTA) at the choroidal level showed relative low flow within the lesion. En face OCT at the level of the choroid demonstrated similar reflectivity to the physiological adjacent choroidal vessels. Conclusion and importance Non-invasive imaging can be used to demonstrate the presence and anatomy of a choroidal macrovessel. OCTA is presented as a useful diagnostic imaging test that can distinguish this lesion from alternative diagnoses without the use of dye injection. In addition to the previously published reports of such vessels in the choroid, we suggest a possible anatomic variant infra-choroidal location of a macrovessel and hypothesize its origin.

Choroidal Macrovessel Diagnosed on Multimodal Imaging, including Swept-Source Optical Coherence Tomography Angiography

“…CM is predominantly observed in the middle age to older Caucasian women [ 4 ]. However, there are reports in younger individuals: a 12-year-old reported by Turgut and Kobat [ 8 ] and a 27-year-old reported by Gallo et al [ 2 ].…”

“…However, there are reports in younger individuals: a 12-year-old reported by Turgut and Kobat [ 8 ] and a 27-year-old reported by Gallo et al [ 2 ]. It can either be asymptomatic or can cause metamorphopsia due to foveal involvement [ 2 , 4 ], often unilateral or rarely bilateral [ 2 ]. Our report demonstrates highly branching CM on ICGA, which was not previously described in the literature.…”

“…OCT angiography (OCTA) is a novel diagnostic modality in the diagnosis of CM noninvasively. There are about half a dozen case reports of CM described on OCTA in the literature [ 2 , 4 , 5 , 6 , 7 ], of which only two reports described CM on swept-source OCTA (SS-OCTA) [ 2 , 6 ]. We describe a CM in an asymptomatic emmetropic elderly Caucasian man on multimodal imaging, including SS-OCTA.…”

Rare case of extramacular choroidal macrovessel

“…Otero-Marquez et al 7 reported a possible association of CM with myopia. They reviewed the fundus images of 13 cases of CM and identified features of high myopia, including fundus tessellation and peripapillary atrophy in 11 of these patients.…”