Difficulties in the diagnosis of achromic fundus lesions and hemorragic lesions

Abstract

SummaryAchromic choroidal lesions can be an achromic melanoma, a choroidal hemangioma or a metastasis. It is rarer to have scleritis ar the origin of an achromic chorodal mass but this can be seen in sarcoidosis rarelyAchromic choroidal melanomas are not rare. They are often mushroom shape and have a typical ultrasonographic aspect. In the presence of an achromic melanoma, it is always important to rule out the possibility of a metastasis by doing a chest and abdominal CT.Metastasis are easy to diagnose when they occur in a patient with known metastatic disease, when they are multiple or bilateral. They are trickier when they are unique with no known previous cancer. This is quite frequent in lung cancer where the choroidal mass is often the first manifestationChoroidal hemangioma have a typical orange color and can be easily diagnosed by indocyanin green angiography (early hyper and wash out on the late phase)Hemorragic mass are frequent in older patient, especially in case of diabetes and high blood pressure. If there is a doubt MRI with gadolinium injections or dopler ultrasonography can easily differentiate a hematoma from, a choroidal tumor