case_images: PMC11791093_01
case_images: Multimodal imaging of choroidal metastases in both eyes from primary lung carcinoma. At the first visit:. (a, b) Ultra-widefield fundus image of right and left eye respectively showing large yellowish choroidal mass lesion with overlying subretinal fluid (SRF) (white arrows) in superior midperiphery encroaching the macula and the inferior midperiphery. (c, d) Ultra-widefield fundus autofluorescence image both eyes (OU) showing central hypoautofluorescence within the choroidal mass lesion surrounded by hyperautofluorescence. (e, f) FFA and ICGA showing hypofluorescence and hypocyanescence within the mass lesion OU. (g, h) Late-phase FFA shows intense leakage at the edges of mass lesion OU, and late-phase ICGA continues to show hypocyanescence OU. (i, j) SD-OCT through the lesions demonstrating a large elevated choroidal hyporeflective lesion, with "lumpy bumpy" overlying RPE and overlying subretinal fluid with elongated shaggy photoreceptors OU.. OS: oculus sinister; OD: oculus dexter; OU: oculus uterque; FFA: fundus fluorescein angiography; ICGA: indocyanine green angiography; SD-OCT: spectral-domain optical coherence tomography; RPE: retinal pigment epithelium.
case_images: cureus-0017-00000076900-i01.jpg
case_images: PMC11791093_01_cureus-0017-00000076900-i01.jpg
case_images: FIG1
case_images: Fundus examination and ultra-widefield imaging (Optos PLC, Dunfermline, United Kingdom) revealed OD, a large yellowish choroidal mass lesion in the superior midperiphery encroaching the macula, with overlying subretinal fluid (SRF) (Figure 1a, Figure 1c). Figure 1d). Fundus fluorescein angiography (FFA) (Heidelberg Retina Angiograph, Heidelberg Engineering, Heidelberg, Germany) showed early hypofluorescence within the mass lesion and intense leakage at the edges of mass lesion in the late phase OU (Figure 1e, Figure 1f, Figure 1g, Figure 1h). Indocyanine green angiography (ICGA) (Heidelberg Retina Angiograph, Heidelberg Engineering, Heidelberg, Germany) showed early and late hypocyanescence within the mass lesion OU (Figure 1e, Figure 1h). Spectral-domain optical coherence tomography (SD-OCT) (RTVue XR Avanti, Optovue Inc., Fremont, CA, USA) through the lesions revealed a large choroidal elevation with retinal pigment epithelium (RPE) undulation and SRF (Figure 1i, Figure 1j).
case_images: At presentation.. (a, b) B-scan ultrasound showing a diffuse homogenous mass lesion involving the retinochoroidal complex with subretinal fluid and medium internal reflectivity OU. (c) Coronal section of CT chest showing heterogeneously enhancing soft tissue density mass lesion (yellow circles) seen in the apical segment of right upper lobe extending up to the right hilar region.. OS: oculus sinister; OD: oculus dexter; OU: oculus uterque.
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case_images: PMC11791093_01_cureus-0017-00000076900-i02.jpg
case_images: FIG2
case_images: Ltd, Aichi, Japan) showed a diffuse homogenous mass lesion involving the retinochoroidal complex with subretinal fluid and medium internal reflectivity OU (Figure 2a, Figure 2b). A computed tomography (CT) scan of the thorax revealed a mass lesion in the apical segment of the right upper lobe with a heterogeneous spiculated margin, encasing the right superior pulmonary artery and causing luminal narrowing (Figure 2c).
case_images: At the 20-week follow-up visit (post 6 cycles of palliative chemotherapy with platinum doublet and systemic bevacizumab):. (a, b) Ultra-widefield fundus image of both eyes (OU) showing flattening of choroidal lesion and alteration in surface pigmentation (white arrows). (c, d) Ultra-widefield fundus autofluorescence image OU showing prominent stippled hypoautofluorescence and hyperautofluorescence. (e, f) FFA and ICGA show normalization of hypofluorescence and hypocyanescence within the mass lesion noted previously OU. (g, h) Late-phase FFA shows stippled hyperfluorescence OU and late-phase ICGA shows normalization of previously noted hypocyanescence OU. (i, j) SD-OCT through the lesions illustrating regression of the choroidal hyporeflective lesion with resolution of overlying subretinal fluid OU.. OS: oculus sinister; OD: oculus dexter; OU: oculus uterque; FFA: fundus fluorescein angiography; ICGA: indocyanine green angiography; SD-OCT: spectral-domain optical coherence tomography.
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case_images: PMC11791093_01_cureus-0017-00000076900-i03.jpg
case_images: FIG3
case_images: After six cycles of chemotherapy (at the 20-week follow-up), fundus examination and ultra-widefield imaging showed complete regression of choroidal lesion OU (Figure 3a, Figure 3b, Figure 3c, Figure 3d). Early phase fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) showed normalization of hypofluorescence and hypocyanescence within the mass lesion noted OU (Figure 3e, Figure 3f) previously. Late-phase FFA showed stippled hyperfluorescence OU, and late-phase ICGA revealed normalization of previously noted hypocyanescence OU (Figure 3g, Figure 3h). SD-OCT demonstrated complete regression of choroidal elevation and SRF OU (Figure 3i, Figure 3j).
case_images: At 20-week follow-up.. (a, b) B-scan ultrasound showing regression of mass lesion with a resolution of overlying subretinal fluid OU. (c) PET-CT scan showing residual lymphatic and primary pulmonary malignant pathology and regressed skeletal metastases.. OU: oculus uterque; PET-CT: Positron Emission Tomography and Computed Tomography.
case_images: cureus-0017-00000076900-i04.jpg
case_images: PMC11791093_01_cureus-0017-00000076900-i04.jpg
case_images: FIG4
case_images: B-scan USG showed complete regression of the subretinal mass lesion OU (Figure 4a, Figure 4b). PET-CT scan revealed residual lymphatic and primary pulmonary malignant pathology and regressed skeletal metastases (Figure 4c).