This case originally appeared here on eye-pix as a blog post entitled: Mystery Diagnosis: Chairman’s Challenge. It’s a fun read about working through a differential diagnosis as an imager. This is a more succinct version of the same case.
- 15 y.o. female
- VA: 20/25 OD 6/200 OS
- IOP: 15/10
- Pupils: Left APD (afferent pupillary defect)
- SLE: WNL OU
- OD: Orange placoid elevated lesion
- OS: Yellow-orange lesion with well-defined borders. Pigmented CNVM w/ subretinal hemorrhage
- B-scan ultrasonography demonstrated classic highly reflective plaque-like structures with an acoustically empty region behind the tumors.
Choriodal osteomas are benign ossifying tumors of the choroid composed of mature bone elements. They are relatively rare and are most commonly found in young women. They often demonstrate a thin plaque-like yellow-tan lesion in the macula with sharp, scalloped borders. They are usually unilateral, but can be bilateral. The tumors usually arise adjacent to the optic nerve. Although they have no malignant potential, they may increase in size on serial examination . Symptoms include metamorphopsia, scotoma, and blurred vision. Vision loss may be due to direct tumor involvement or secondary to choroidal neovascularization with subretinal fluid, lipid, or hemorrhage.
Our patient deferred a fluorescein angiogram to a later date, but was lost to followup. I had previously encountered a similar case nearly twenty years ago. It was before the advent of OCT, but the osteoma was well documented with multi-spectral monochromatic imaging, color fundus photography, fluorescein angiography and B-scan ultrasonography.
Choriodal osteoma is a rare condition that may present for diagnostic imaging. The appearance is quite striking and can be well documented with several different imaging modalities.