Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute Of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Department of Radiodiagnosis, All India Institute Of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Med Hypotheses. 2020 Jun;139:109695. doi: 10.1016/j.mehy.2020.109695. Epub 2020 Mar 28.
We here hypothesize the scleral origin of 'Solitary Idiopathic Choroiditis', a yellowish, nodular lesion that resembles other choroidal tumors. Systemic investigations were done to rule out causes like tuberculosis and sarcoidosis. Multimodal imaging was done for better characterization and to distinguish it from other choroidal lesions. Fundus imaging revealed a yellowish-orange, well-defined nodular lesion resembling solitary idiopathic choroiditis inferotemporal to the disc. Swept source optical coherence tomography (SSOCT) showed a nodular lesion arising from the sclera with compression of overlying choroid. Indocyanine green angiography (ICGA) showed hypofluorescence in all phases of angiogram with displacement of major choroidal vessels along the walls of the mass and loss of overlying choriocapillaries. The same was evident on Swept Source optical coherence tomography angiography (SSOCTA) as well. Fundus autofluorescence (FAF) showed central hypofluoresence with surrounding hyperfluorescence. Ultrasound (USG) B scan revealed a high reflective echo at the apex of the mass with moderate internal reflectivity without any evidence of calcification. Enhanced Infrared (IR) Reflectance imaging revealed a central intense hyerreflective area suggestive of a fibrotic mass. Magnetic reasonance imaging (MRI) revealed a focal hypointense nodular lesion on T2-weighted image. The central white area at the apex with corresponding hypoautofluorescence, a high spike on ultrasound, intense hyperreflectivity on enhanced Infrared reflectance, lack of vascularity and displacement of choroidal vessels is suggestive of a scleral origin of the mass and likely fibrotic nature.
我们推测“孤立性特发性脉络膜炎”的巩膜起源，这是一种类似其他脉络膜肿瘤的黄色结节性病变。进行了系统检查以排除结核病和结节病等原因。进行了多模态成像以更好地进行特征描述并将其与其他脉络膜病变区分开来。眼底成像显示，在盘状下的颞侧有一个类似于孤立性特发性脉络膜炎的黄色橙色，界限分明的结节状病变。扫频源光学相干断层扫描（SS-OCT）显示，巩膜上有一个结节状病变，伴有上方脉络膜受压。吲哚菁绿血管造影（ICGA）显示在造影的所有阶段均呈弱荧光，主要脉络膜血管沿肿块壁移位，上方脉络膜毛细血管丧失。扫频源光学相干断层扫描血管造影（SS-OCTA）也显示出相同的情况。眼底自发荧光（FAF）显示中央弱荧光，周围强荧光。超声（USG）B 扫描显示在肿块顶点有一个高反射回波，内部反射中度，没有任何钙化迹象。增强红外（IR）反射成像显示中央强烈的高反射区域提示为纤维性肿块。磁共振成像（MRI）显示 T2 加权图像上有一个局灶性低信号结节状病变。中央白色区域在顶点对应低自发荧光，超声上有一个高尖峰，增强红外反射上有强烈的高反射性，缺乏血管和脉络膜血管移位提示肿块起源于巩膜，可能具有纤维性。
