Atlas Entry - Circumscribed choroidal hemangioma

Circumscribed choroidal hemangioma

Category(ies): Retina, Vitreous

Contributor: Jesse Vislisel, MD

Choroidal hemangiomas are benign vascular hamartomas that can be diffuse (as seen in the case of Sturge-Weber syndrome) or circumscribed as shown here. They typically are red-orange in color with indistinct margins and are located in the posterior pole. There may be overlying retinal pigmented epithelium (RPE) changes or orange pigment. The lesions may have associated intraretinal or subretinal fluid. They display high internal reflectivity on A-scan echography.

Figure 1

Contributor: Jesse Vislisel, MD

Photographer: Randy Verdick, FOPS (figs. 1a, 1b); Antionette Venckus, CRA (fig. 1f)

These photographs show the appearance of a circumscribed choroidal hemangioma before and after treatment with photodynamic therapy (PDT). The lesion appeared as an elevated choroidal mass with overlying orange plaques and RPE atrophy. Vascular leakage from the lesion resulted in macular edema overlying the lesion, as seen in the OCT, and surrounding subretinal fluid resulting in an exudative retinal detachment, as seen on the B-scan echography. A-scan echography revealed high internal reflectivity, which is typical for these lesions. Overlying fibrosis can be seen in the post-treatment photograph. The treatment resulted in a reduction in tumor height and decreased subretinal fluid. It was successful in decreasing the patient's metamorphopsia.

circumscribed choroidal hemangioma fundus OD — Figure 1a

Enlarge Download

circumscribed choroidal hemangioma fundus montage OD — Figure 1b

Enlarge Download

circumscribed choroidal hemangioma OCT — Figure 1c

Enlarge Download

circumscribed choroidal hemangioma B-scan ultrasound — Figure 1d: B-scan ultrasound

Enlarge Download

circumscribed choroidal hemangioma a-scan ultrasound — Figure 1e: A-scan ultrasound

Enlarge Download

circumscribed choroidal hemangioma fundus montage post treatment — Figure 1f

Enlarge Download

Figure 2

Contributor: Eric Chin, MD

These photographs show the appearance of circumscribed choroidal hemangiomas in two different patients (Figures 2a and 2b are one patient, figures 2c and 2d are another).

circumscribed choroidal hemangioma fundus montage figure 2 — Figure 2a

Enlarge Download

circumscribed choroidal hemangioma fundus figure 2 — Figure 2b

Enlarge Download

Figure 3

Contributor: Greg Zablocki, Retina Consultants of Colorado, P.C.

This patient presented with a visually-significant choroidal hemangioma. The patient underwent photodynamic therapy employing the technique of Michels et al. After infusion of 6mg/m2 of verteporfin (Visudyne) intravenously the lesion was illuminated for 163 seconds with the activating laser. Two months later vision had improved from 20/70 to 20/30 and the sub-retinal fluid had resolved clinically and on OCT.