Purpose: To describe the clinical, optical coherence tomography, and echographic findings of a choroidal metastasis in the macula. An initial, erroneous diagnosis of a serous pigment epithelial detachment of the macula had been based on ophthalmoscopic and optical coherence tomography findings.
Methods: Case report of a patient with blurred vision in one eye and presumed serous pigment epithelial detachment.
Results: An 83-year-old man with blurred vision and presumed serous pigment epithelial detachment was self-referred to our clinic for a second opinion. Optical coherence tomography showed an elevation of the neurosensory macula, but no abnormalities were reflected from the choroid. We performed an ultrasound evaluation, which revealed a solid mass involving the macular region of the choroid. The echo-graphic characteristics, including low internal reflectivity, regular structure, and vas-cularity, were consistent with choroidal melanoma or metastasis from any small cell carcinoma. The patient was not aware of any active primary tumor. An extensive systemic workup was performed. His prostate-specific antigen was found to be elevated to 61.4 ng/mL, and a prostate biopsy was positive for adenocarcinoma. Additional studies revealed metastatic disease involving the bones, pulmonary parenchyma, and mediastinal and retroperitoneal lymph nodes.
Conclusion: Ultrasound imaging was superior to optical coherence tomography imaging in the clinical setting of a choroidal mass in the macula.