Differential diagnosis of peripheral exudative hemorrhagic chorioretinopathy and neoplasm of the choroid (clinical case)

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Abstract

Peripheral exudative hemorrhagic chorioretinopathy is a relatively rare and difficult to diagnose disease. This condition is clinically similar to choroidal melanoma, which is why it is called “pseudomelanoma”. An erroneous diagnosis of choroidal melanoma can lead to the wrong choice of aggressive treatment tactics. The aim of this work was to present a case of differential diagnosis of suspected neoplasm of the choroid with peripheral exudative hemorrhagic chorioretinopathy. The described clinical case demonstrates characteristic clinical picture and results of ultrasound with Doppler mapping, spectral optical coherence tomography, optical coherence tomography–angiography, scanning laser ophthalmoscopy for this condition, as well as important differential diagnostic signs of choroidal melanoma. Complaints, history, clinical picture and the results of instrumental examinations were characteristic of peripheral exudative hemorrhagic chorioretinopathy and allowed to exclude the diagnosis of choroidal neoplasm. Pathogenetic treatment (intravitreal injection of anti-VEGF agents) and observation were recommended to the patient, since this disease often affects both eyes. The main differential diagnostic criterion for suspected choroidal melanoma is Doppler ultrasound imaging. In difficult clinical cases, structural optical coherence tomography, optical coherence tomography–angiography, and scanning laser ophthalmoscopy provide valuable additional information for verifying the diagnosis.

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About the authors

Yuliya V. Getmantseva

S.M. Kirov Military Medical Academy

Email: getmancevaa@gmail.com

clinical resident

Russian Federation, 6, Acad. Lebedevа str., Saint Petersburg, 194044

Anna Y. Malafeeva

S.M. Kirov Military Medical Academy

Email: anutka.kuznetsova@gmail.com

MD, Ophthalmologist

Russian Federation, 6, Acad. Lebedevа str., Saint Petersburg, 194044

Matvey V. Alyabev

S.M. Kirov Military Medical Academy

Email: condratpr70@yandex.ru

Candidate of Medical Sciences, Deputy Head of the Department of Ophthalmology

Russian Federation, 6, Acad. Lebedevа str., Saint Petersburg, 194044

Alexei N. Kulikov

S.M. Kirov Military Medical Academy

Email: alexey.kulikov@mail.ru
ORCID iD: 0000-0002-5274-6993

Doctor of Medical Science, Head of the Department Ophthalmology

Russian Federation, 6, Acad. Lebedevа str., Saint Petersburg, 194044

Dmitrii S. Maltsev

S.M. Kirov Military Medical Academy

Author for correspondence.
Email: glaz.med@yandex.ru
ORCID iD: 0000-0001-6598-3982

Doctor of Medical Science, Ophthalmologist

Russian Federation, 6, Acad. Lebedevа str., Saint Petersburg, 194044

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Supplementary files

Supplementary Files
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1. Fig. 1. Color fundus photography with oval mass

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2. Fig. 2. Ultrasound procedure: a – B-scan mode; b – Doppler mapping mode

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3. Fig. 3. Optical coherence tomography angiography: a – structural, retinal detachment is visualized; b – angiography, vascular network

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4. Fig. 4. Image of infrared scanning laser ophthalmoscopy in retro mode shows a round mass

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Copyright (c) 2021 Getmantseva Y.V., Malafeeva A.Y., Alyabev M.V., Kulikov A.N., Maltsev D.S.

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