Varix of the vortex vein ampulla simulating choroidal melanoma: report of four cases.

BACKGROUND

Varix of the vortex vein ampulla is a condition that can cause diagnostic confusion with choroidal melanoma.

METHODS

A case series review was performed from the Ocular Oncology Service, Wills Eye Hospital.

RESULTS

In all four cases, the patients were referred with the diagnosis of a small choroidal melanoma. The lesions were located in the nasal quadrant of the fundus near the equator. One patient had two lesions in the same quadrant. In all cases, the fundus lesion became more prominent when the eye gazed in the direction of the lesion and diminished in primary gaze. The mass measured up to 6.0 mm in base diameter and 2.5 mm in thickness in proper gaze. B-scan ultrasonography showed acoustic solidity and gaze-evoked dynamic enlargement of the lesion. Indocyanine green angiography demonstrated early pooling of dye and gaze-evoked fluctuation of the hyperfluorescence in the lesion. Color Doppler imaging, performed in one patient, showed a vascular lesion of venous origin that filled when the eye was placed in the direction of the lesion.

CONCLUSIONS

Varix of the vortex vein is a condition that should be considered in the differential diagnosis of equatorial small choroidal melanoma. The dynamic nature of the lesion is characteristic and diagnostic.