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

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.

Keywords

peripheral exudative hemorrhagic chorioretinopathy / polypoid choroidal vasculopathy / choroidal melanoma / ultrasound mapping / scanning laser ophthalmoscopy / optical coherence tomography

References

[1] Brovkina AF. Differentsial’naya diagnostika melanomy khorioidei. Ophthalmology Journal. 2008;1(4):68–76. (In Russ.)

[2] Бровкина А.Ф. Дифференциальная диагностика меланомы хориоидеи // Офтальмологические ведомости. 2008. Т. 1, № 4. С. 68–76.

[3] Takayama K, Enoki T, Kojima T, et al. Treatment of peripheral exudative hemorrhagic chorioretinopathy by intravitreal injections of ranibizumab. Clin Ophthalmol. 2012;2012(6):865–869. DOI: 10.2147/OPTH.S31640

[4] Takayama K., Enoki T., Kojima T., et al. Treatment of peripheral exudative hemorrhagic chorioretinopathy by intravitreal injections of ranibizumab // Clin Ophthalmol. 2012. Vol. 2012. No. 6. P. 865–869. DOI: 10.2147/OPTH.S31640

[5] Vandefonteyne S, Caujolle J-P, Rosier L, et al. Diagnosis and treatment of peripheral exudative haemorrhagic chorioretinopathy. Br J Ophthalmol. 2020;104(6):874–878. DOI: 10.1136/bjophthalmol-2018-313307

[6] Vandefonteyne S., Caujolle J.-P., Rosier L., et al. Diagnosis and treatment of peripheral exudative haemorrhagic chorioretinopathy // Br J Ophthalmol. 2020. Vol. 104. No. 6. P. 874–878. DOI: 10.1136/bjophthalmol-2018-313307

[7] Stoffelns B, Laspas P, Arad T. Peripheral Exudative Hemorrhagic Chorioretinopathy (PEHCR) Simulating a Malignant Melanoma of the Choroid. Klin Monbl Augenheilkd. 2019;236(4):575–577. DOI: 10.1055/a-0832-1770

[8] Stoffelns B., Laspas P., Arad T. Peripheral Exudative Hemorrhagic Chorioretinopathy (PEHCR) Simulating a Malignant Melanoma of the Choroid // Klin Monbl Augenheilkd. 2019. Vol. 236. No. 4. P. 575–577. DOI: 10.1055/a-0832-1770

[9] Mazal Z. Peripheral exudative hemorrhagic chorioretinopathy. Cesk Slov Oftalmol. 2019;75(2):80–84. DOI: 10.31348/2019/2/4

[10] Mazal Z. Peripheral exudative hemorrhagic chorioretinopathy // Cesk Slov Oftalmol. 2019. Vol. 75. No. 2. P. 80–84. DOI: 10.31348/2019/2/4

[11] Samkovich EV, Panova IE. Doppler ultrasound imaging in the study of blood supply to choroidal melanoma. Medicine. 2020;8(1):125–135. (In Russ.) DOI: 10.29234/2308-9113-2020-8-1-125-135

[12] Самкович Е.В., Панова И.Е. Ультразвуковое исследование в режиме цветового допплеровского картирования в изучении кровоснабжения меланомы хориоидеи // Медицина. 2020. Т. 8, № 1. С. 125–135. DOI: 10.29234/2308-9113-2020-8-1-125-135

[13] Doga AV, Pedanova EK, Volodin PL, Mayorova AM. Current aspects of diagnosis and treatment of polypoidal choroidal vasculopathy. Fyodorov Journal of Ophthalmic Surgery. 2017;(1):88–92. (In Russ.) DOI: 10.25276/0235-4160-2017-1-88-92

[14] Дога А.В., Педанова Е.К., Володин П.Л., Майорова А.М. Современные аспекты диагностики и лечения полипоидной хориоидальной васкулопатии // Офтальмохирургия. 2017. № 1. С. 88–92. DOI: 10.25276/0235-4160-2017-1-88-92

[15] Brovkina AF, Stoyukhina AS, Musatkina IV. Circumscribed choroidal hemangioma: clinical course and treatment. Russian Journal of Clinical Ophthalmology. 2020;20(2):56–62. (In Russ.) DOI: 10.32364/2311-7729-2020-20-2-56-62

[16] Бровкина А.Ф., Стоюхина А.С., Мусаткина И.В. Отграниченная гемангиома хориоидеи: особенности течения, лечение // Клиническая офтальмология. 2020. Т. 20, № 2. С. 56–62. DOI: 10.32364/2311-7729-2020-20-2-56-62

RIGHTS & PERMISSIONS

Getmantseva Y.V., Malafeeva A.Y., Alyabev M.V., Kulikov A.N., Maltsev D.S.