History of present illness
A 65-year-old man with an unremarkable past medical history was referred for concern of intraocular lymphoma. He denies visual symptoms in either eye.
Ocular examination findings
Visual acuity was 20/25. Intraocular pressure was normal. External and anterior segment examination showed pseudophakia in each eye. Dilated fundus examination showed a yellow circinate lesion superotemporally in the right eye ( Fig. 54.1 ). No vitreous cell or haze was present.
Imaging
Fundus autofluorescence showed a target-shaped ring of hyperautofluorescence over the lesion ( Fig. 54.2 ). Optical coherence tomography (OCT) revealed a dramatic elevation, without expansion of the choroid, in the area ( Fig. 54.3 ). B scan ultrasound demonstrated a focal hyperechoic lesion with significant posterior shadowing in the choroid or sclera ( Fig. 54.4 ).
Questions to ask
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Has the patient had a history of malignancy? Metastatic lesions can be solitary or multifocal and can be yellow or creamy in color.
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No
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Is there associated vitreous haze or cells? Primary vitreoretinal lymphoma commonly demonstrates prominent vitreous haze or cells.
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No
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Are there any known electrolyte abnormalities? Sclerochoroidal calcifications may be secondary to systemic electrolyte abnormalities.
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No
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Does the patient have any known parathyroid or kidney problems? Sclerochoroidal calcifications may be associated with parathyroid or kidney conditions.
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No
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Assessment
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This is a case of a 65-year-old man with no pertinent medical history and with a yellow circinate lesion in the superotemporal near periphery that shows hyperautofluorescence and shadowing on ultrasound.
Differential diagnosis
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Sclerochoroidal calcification
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Presumed solitary circumscribed retinal astrocytic proliferation
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Choroidal osteoma
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Focal scleral nodule
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Primary vitreoretinal lymphoma
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Choroidal neovascular membrane
Working diagnosis
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Sclerochoroidal calcification
Multimodal testing and results
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Fundus photography
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On fundus examination, a hypopigmented arc-shaped or circinate lesion in the superotemporal, or less commonly inferotemporal, near periphery is typical. Findings are usually identified in patients over the age of 55 years. In some cases, the lesions can be quite large ( Fig. 54.5 ) and cover a large area. ,
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