Circumscribed Choroidal Hemangioma in a child - 2025 09 12 - Kim Menezes, MD скачать в хорошем качестве

Circumscribed Choroidal Hemangioma in a child - 2025 09 12 - Kim Menezes, MD

This case features a 10-year-old child with progressive hyperopic shift in the left eye over several years, ultimately revealing a large reddish-orange peripapillary lesion consistent with choroidal hemangioma. Imaging showed a 5.5 mm by 15 mm elevated hyperechoic lesion on B-scan, with MRI unremarkable. The key clinical clue was the marked refractive change—about 6 diopters of hyperopia—highlighting how even benign intraocular tumors can produce significant visual symptoms through refractive shifts and secondary complications. The teaching focus is on differentiating circumscribed versus diffuse choroidal hemangiomas. Circumscribed lesions are isolated, benign vascular hamartomas, typically presenting in the 2nd to 4th decades, often with blurred vision or metamorphopsia from serous retinal detachment. Diffuse hemangiomas, by contrast, are associated with Sturge-Weber syndrome, where the classic triad includes ipsilateral facial port-wine stain, choroidal hemangioma, and leptomeningeal angioma. Imaging pearls include hyperfluorescence on fluorescein angiography, early hyperfluorescence with “washout” on ICG, and subtle OCT findings with minimal intrinsic signal. High-yield points include: expected refractive shift of ~3 diopters per 1 mm elevation of the retina, and that treatment is indicated when there is vision-threatening retinal detachment or glaucoma. Photodynamic therapy (PDT) is the mainstay for circumscribed cases, while radiation may be used in refractory situations. Observation is appropriate if asymptomatic. Prognosis is generally favorable, with regression of both tumor and subretinal fluid once treated. This case underscores the importance of recognizing choroidal hemangioma early, linking refractive changes with underlying pathology, and tailoring management to preserve long-term vision