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Hémorragie du vitré comme la première manifestation d’un ostéome choroïdien avec néovascularisation

This clinical case has the goal to describe de diferential diagnosis of vitreous hemorrage in a young adult and point out  the clinical and imagenologic characteristics that may guide for final diagnosis and treatment

A  20 years old female with abruptal  loss of  rigth eye visual function with  choroidal osteoma  and  neovascularization mascaraded  by a vitreous hemorrage observed  during clinical examination and A/B ocular ultrasound and  documented  after vitrectomy by   angiography and OCT is  reported.

A  20 years old female with abruptal  loss of  rigth eye visual function with  choroidal osteoma  and  neovascularization mascaraded  by a vitreous hemorrage observed  during clinical examination and A/B ocular ultrasound and  documented  after vitrectomy by   angiography and OCT is  reported.

Choroidal osteoma is a benign ossifying tumor characterized by mature bone replacing choroid. The etiology of the tumor is unknown but factors implicated in its development, however, include inflammation, trauma, hormonal state, calcium metabolism, environment, and heredity. On fundus exam, choroidal osteoma appears as a juxtapapillary or peripapillary lesion that is yellow-white to orange-red in color with clumping of brown, orange, or gray pigment. Thin, atrophic, yellow-gray regions with associated RPE atrophy represent areas of decalcification. Choroidal neovascularization can also be observed along with retinal serous detachment and intraretinal, or vitreous hemorrage extremely unfrecuently, as shown in this case 

A vitreous hemorrage without  any previous ocular trauma in a young healthy female has to be diferentiated from posterior vitreous detachment with a tear, vasculitis, Eales disease, pars planits, systemic lupus and  vascular pathology such as diabetic retinopathy and vascular oclusions among others. A clinical history and a complete physical examination may guide the clinician to the final diagnosis, however in this case, ocular ultrasound was a great aid because on A/B mode, a high amplitude of the echo spike is observed . B scan shows slightly elevated, highly reflective choroidal mass with acoustic shadowing that gives an appearance of “pseudo-optic nerve”. The mass persists at lower scanning sensitivity after the other soft tissue echoes have disappeared.  Fluorescein angiography shows early patchy hyperfluorescence with late diffuse staining. Optical coherence tomography (OCT) can also be utilized in the cases of choroidal neovascularization.

In the event of vitreous hemorrage  in previous helthy subjects like this female, it is very important to determine what may be the ethiological outcome  and the diferential diagnosis, never the less, a good clinical and imagenologic methodology may led us to the final diagnosis and treatment