Instituto de Oftalmologia Dr. Gama Pinto, Lisboa, Portugal ; and.
NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
Retin Cases Brief Rep. 2022 May 1;16(3):325-328. doi: 10.1097/ICB.0000000000000968. Epub 2020 Jan 9.
To describe a patient with a painful red-eye syndrome and a choroidal mass lesion that was diagnosed after multimodal imaging with a vortex vein ampulla varix induced by a nodular posterior scleritis.
Retrospective case report documented with fluorescein angiography, indocyanine green angiography, b-mode ultrasound, fundus imaging, and swept-source optical coherence tomography.
A 24-year-old man presented with a painful red eye and sudden onset blurred vision. Fundus exam disclosed macular choroidal folds and a nonpigmented mass lesion at the inferior equator. Swept-source optical coherence tomography showed enlarged choroidal vessels with fluid in the suprachoroidal space under the central macula and a hyporeflective lobulated choroidal cavity in the inferior temporal retina. Multimodal imaging with contrast dyes showed a dilated vortex vein ampulla with early hyperfluorescence and a complete washout in late acquisitions on indocyanine green. The patient recovered uneventfully after a short-course administration of oral nonsteroidal anti-inflammatory drugs, disclosing irregular scleral nodules on swept-source optical coherence tomography that remained stable over a twelve-month follow-up.
This report suggests that nodular posterior scleritis can induce a vortex vein ampulla varix and contributes to a better understanding of the pathophysiology of this entity. We further suggest that in a diagnostic puzzling scenario the inflammatory syndrome should be treated before attempting to perform a chorioretinal biopsy.
描述一位患有疼痛性红眼综合征和脉络膜肿块病变的患者，该患者在结节性后部巩膜炎引起的涡静脉壶腹静脉曲张的多模态成像后被诊断。
回顾性病例报告，记录了荧光素血管造影、吲哚青绿血管造影、B 型超声、眼底成像和扫频源光相干断层扫描。
一名 24 岁男性因疼痛性红眼和突发性视力模糊就诊。眼底检查显示黄斑脉络膜皱褶和下赤道处无色素肿块病变。扫频源光相干断层扫描显示脉络膜血管扩张，中央黄斑下巩膜腔内有液体，下颞部视网膜有低反射分叶状脉络膜腔。对比染料的多模态成像显示涡静脉壶腹扩张，早期出现高荧光，吲哚青绿晚期完全洗脱。患者在短期口服非甾体抗炎药治疗后恢复良好，扫频源光相干断层扫描显示不规则的巩膜结节，在 12 个月的随访中保持稳定。
本报告表明结节性后部巩膜炎可引起涡静脉壶腹静脉曲张，并有助于更好地理解该疾病的病理生理学。我们进一步建议，在出现诊断难题的情况下，应在尝试进行脉络膜视网膜活检之前先治疗炎症综合征。
