Marous Charlotte L, Sioufi Kareem, Shields Carol L, Mashayekhi Arman, Shields Jerry A
Division of Ophthalmology, Saint George's University School of Medicine, Great River, New York.
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
Retin Cases Brief Rep. 2018;12(4):336-341. doi: 10.1097/ICB.0000000000000502.
To describe two cases of coughing-induced suprachoroidal hemorrhage referred as choroidal melanoma.
Observational case reports.
Two female patients (ages 54 and 60 years) were referred with possible choroidal melanoma. Both gave a history of 1 day of heavy coughing with Valsalva maneuver within 2 weeks before discovery of the tumor. In one case, the patient used anticoagulants for aortic valve replacement and the other patient used antiasthma medications. One patient noted sharp ocular pain one week before presentation to this service. In both cases, the choroidal lesion was at the globe equator, near a vortex ampulla, and appeared homogeneously dark brown and with acoustic hollowness on ultrasonography, concerning for choroidal melanoma. However, neither lesion demonstrated intrinsic vascularity on fluorescein angiography or indocyanine angiography. Both lesions showed isoautofluorescence and optical coherence tomography evidence of shallow choroidal folds with inner choroidal elevation over a dome-shaped, optically-lucent deep choroidal mass, consistent with suprachoroidal hemorrhage. Fine needle aspiration biopsy in 1 case confirmed blood without melanoma. Both cases were observed with complete spontaneous resolution of the hemorrhage and normal-appearing choroid within 2 months.
Coughing-induced suprachoroidal hemorrhage can simulate melanoma. Clinical and imaging features can assist in diagnosis. The hemorrhage generally resolves within few months.
描述两例被误诊为脉络膜黑色素瘤的咳嗽诱发脉络膜上腔出血病例。
观察性病例报告。
两名女性患者（年龄分别为54岁和60岁）被转诊，疑似脉络膜黑色素瘤。两人均有在发现肿瘤前2周内进行过1天剧烈咳嗽伴瓦尔萨尔瓦动作的病史。其中1例患者因主动脉瓣置换使用抗凝剂，另1例患者使用抗哮喘药物。1例患者在就诊前1周出现眼部剧痛。在这两例中，脉络膜病变均位于眼球赤道部，靠近涡静脉壶腹，超声检查显示为均匀的深褐色，且有声学空洞，疑似脉络膜黑色素瘤。然而，在荧光素血管造影或吲哚菁绿血管造影中，两个病变均未显示内在血管。两个病变均显示等自发荧光，光学相干断层扫描显示在一个圆顶形、光学透明的深脉络膜肿块上方有浅脉络膜褶皱和脉络膜内层隆起，符合脉络膜上腔出血。1例患者的细针穿刺活检证实为血液，无黑色素瘤。两例均进行观察，出血在2个月内完全自发消退，脉络膜外观恢复正常。
咳嗽诱发的脉络膜上腔出血可模拟黑色素瘤。临床和影像学特征有助于诊断。出血通常在几个月内消退。
