Choroidal Hemangioma | B-Scan Eye Pathology

Diagnostic Sonography • B-Scan Eye Pathology Atlas

Choroidal Hemangioma

A structured ocular ultrasound case collection covering circumscribed and diffuse choroidal hemangioma, with emphasis on lesion contour, acoustic character, internal reflectivity, measurements and associated subretinal fluid or exudative retinal detachment.

OCULAR ULTRASOUNDB-SCANA-SCANCHOROID7 CASES

Choroidal Hemangioma — Sonographic Morphology Index

01Circumscribed Choroidal Hemangioma→

02Choroidal Hemangioma with Subretinal Fluid→

03Diffuse Choroidal Hemangioma→

04Prominent Circumscribed Choroidal Hemangioma→

05Choroidal Hemangioma Mimicking Melanoma→

06Choroidal Hemangioma with Exudative Retinal Detachment→

07Follow-Up Assessment of Choroidal Hemangioma→

Educational note: Typical circumscribed choroidal hemangioma appears on B-scan as a dome-shaped/fusiform acoustically solid choroidal mass, with high internal reflectivity on A-scan. Diffuse lesions may instead produce generalized posterior choroidal thickening. Subretinal fluid and exudative retinal detachment may accompany the lesion. These findings require correlation with clinical and multimodal ocular imaging.

Chapter 01 • Case Study

Circumscribed Choroidal Hemangioma

01Clinical History

Adult patient referred for characterization of a localized posterior choroidal mass. B-scan is requested to define lesion contour, internal echotexture, dimensions and associated retinal/subretinal changes.

02Ultrasound Image

Figure 1. B-scan appearance of a circumscribed choroidal hemangioma.

03Ultrasound Morphology

Feature	Sonographic Description
Location	Usually a localized posterior choroidal lesion.
Configuration	Smooth, dome-shaped, fusiform or biconvex choroidal mass.
Internal echotexture	Homogeneous and similar in echogenic character to surrounding choroid.
B-scan character	Acoustically solid without the typical acoustic hollowness of melanoma.
A-scan reflectivity	Typically high internal reflectivity.
Attenuation	No significant acoustic shadowing/attenuation is expected in the typical lesion.

04Ultrasound Report

Well-defined smooth choroidal mass demonstrating homogeneous internal echotexture and acoustic solidity. The lesion is mildly elevated with a broad basal dimension. A-scan, when available, demonstrates relatively high internal reflectivity. The sonographic appearance is compatible with circumscribed choroidal hemangioma in the appropriate clinical setting.

05Impression

Sonographic ImpressionSonographic features favor a circumscribed choroidal hemangioma.

06Recommendation

Correlate with fundus examination and multimodal imaging such as OCT, fluorescein angiography and/or indocyanine green angiography as clinically indicated. Record baseline lesion dimensions for follow-up.

07Learning Points

On B-scan, a typical circumscribed hemangioma is a dome-shaped acoustically solid choroidal mass.

A-scan generally demonstrates high internal reflectivity.

The lesion often has a broad base and relatively modest height.

Interpret ultrasound together with clinical and multimodal imaging findings.

Chapter 02 • Case Study

Choroidal Hemangioma with Subretinal Fluid

01Clinical History

Patient presents with blurred vision or metamorphopsia. Clinical examination/OCT suggests a choroidal vascular lesion with associated serous retinal elevation. Ultrasound is performed to assess the mass and posterior segment.

02Ultrasound Image

Figure 1. Choroidal hemangioma with associated subretinal fluid / exudative retinal elevation.

03Ultrasound Morphology

Feature	Sonographic Description
Mass	Smooth, well-defined choroidal mass with homogeneous internal echoes.
Internal reflectivity	Relatively high internal reflectivity / acoustic solidity.
Subretinal fluid	Anechoic or low-level fluid may separate the elevated retina from the posterior wall.
Retinal elevation	May represent secondary exudative retinal detachment.
Dynamic assessment	Assess the detached retinal contour and mobility.
Measurement	Document tumor thickness separately from associated retinal fluid when possible.

04Ultrasound Report

Smooth acoustically solid choroidal mass with homogeneous internal echoes and associated subretinal fluid/exudative retinal elevation. The mass remains distinct from the fluid component. No definite calcific shadowing is demonstrated.

05Impression

Sonographic ImpressionChoroidal hemangioma with associated subretinal fluid / exudative retinal detachment.

06Recommendation

Correlate with OCT to assess macular involvement and with angiographic imaging when indicated. Compare both lesion thickness and fluid extent with prior examinations.

07Learning Points

Subretinal fluid is an important complication of choroidal hemangioma.

Ultrasound can demonstrate both the mass and associated retinal elevation.

Serial documentation should distinguish tumor thickness from fluid-related retinal elevation.

OCT is particularly useful for characterizing associated retinal/subretinal fluid.

Chapter 03 • Case Study

Diffuse Choroidal Hemangioma

01Clinical History

Patient with diffuse posterior choroidal thickening, particularly in a clinical setting suggestive of diffuse choroidal hemangioma. Dynamic B-scan is used to assess the posterior wall and exclude a dominant discrete mass.

02Ultrasound Image

Figure 1. B-scan appearance of diffuse choroidal hemangioma.

03Ultrasound Morphology

Feature	Sonographic Description
Pattern	Diffuse posterior choroidal thickening rather than a sharply circumscribed mass.
Echotexture	Moderately bright and relatively homogeneous.
Posterior wall	Generalized thickening may involve a broad posterior segment.
Discrete mass	A dominant dome-shaped mass may be absent.
Associated findings	Exudative retinal detachment or other posterior segment changes may coexist.
Clinical context	Correlation with associated facial/ocular vascular findings may be important.

04Ultrasound Report

Diffuse smooth thickening of the posterior choroid is demonstrated with relatively increased echogenicity and no dominant discrete choroidal mass. The appearance may be compatible with diffuse choroidal hemangioma when correlated with the clinical setting.

05Impression

Sonographic ImpressionDiffuse posterior choroidal thickening, suspicious for diffuse choroidal hemangioma in the appropriate clinical context.

06Recommendation

Correlate with fundus examination and multimodal ocular imaging. Document the extent of choroidal thickening and any associated exudative retinal changes.

07Learning Points

Diffuse hemangioma differs from the circumscribed form by producing generalized choroidal thickening.

B-scan may show a moderately bright thickened posterior choroid.

A dominant dome-shaped mass may not be present.

Clinical correlation is particularly important for diffuse lesions.

Chapter 04 • Case Study

Prominent Circumscribed Choroidal Hemangioma

01Clinical History

Patient referred for characterization and measurement of a relatively prominent choroidal mass. The study is performed in multiple planes to document the maximum lesion dimensions.

02Ultrasound Image

Figure 1. Prominent circumscribed choroidal hemangioma on B-scan.

03Ultrasound Morphology

Feature	Sonographic Description
Margins	Smooth and relatively well-defined.
Shape	Dome-shaped, fusiform or biconvex.
Internal echoes	Homogeneous and relatively echogenic.
Acoustic character	Solid with echogenicity similar to surrounding choroid.
Dimensions	Record maximum apical height and basal diameter in standardized planes.
Associated changes	Assess for subretinal fluid and retinal detachment.

04Ultrasound Report

Prominent smooth choroidal mass with homogeneous internal echoes and acoustic solidity. The lesion is measured in orthogonal planes, with associated retinal/subretinal changes assessed separately.

05Impression

Sonographic ImpressionProminent circumscribed choroidal mass with sonographic features favoring choroidal hemangioma.

06Recommendation

Document maximum thickness and basal dimensions using reproducible scan planes. Correlate with OCT/angiographic imaging and prior studies.

07Learning Points

Consistent measurement technique is essential for follow-up.

Shape, internal reflectivity and acoustic character should be assessed together.

Associated subretinal fluid should be documented separately.

A large lesion can still retain the typical solid sonographic pattern.

Chapter 05 • Case Study

Choroidal Hemangioma Mimicking Melanoma

01Clinical History

Patient with an elevated choroidal lesion requiring characterization and differential assessment, particularly against an amelanotic choroidal melanoma. B-scan and A-scan findings are reviewed together.

02Ultrasound Image

Figure 1. Choroidal hemangioma in the differential diagnosis of an elevated choroidal mass.

03Ultrasound Morphology

Feature	Sonographic Description
Hemangioma shape	Usually smooth dome-shaped, fusiform or biconvex.
Hemangioma reflectivity	Typically high internal reflectivity on A-scan.
Hemangioma B-scan	Acoustically solid, often similar to surrounding choroid.
Melanoma comparison	Melanoma more commonly shows low-to-medium reflectivity and acoustic hollowness.
Fluid	Both lesions may be associated with subretinal fluid.
Interpretation	Ultrasound findings should be integrated with clinical and multimodal imaging.

04Ultrasound Report

Choroidal mass demonstrates a smooth contour, homogeneous echotexture and acoustic solidity. The sonographic pattern is more supportive of hemangioma than a classically acoustically hollow melanoma, although ultrasound alone is not diagnostic.

05Impression

Sonographic ImpressionSonographic appearance favors choroidal hemangioma; melanoma remains an important differential diagnosis for a choroidal mass.

06Recommendation

Correlate with fundus findings, OCT, fluorescein angiography and/or ICGA as clinically appropriate. Consider the full multimodal imaging pattern rather than a single ultrasound feature.

07Learning Points

Choroidal hemangioma can mimic amelanotic melanoma clinically.

High internal reflectivity and acoustic solidity are useful supportive features.

Melanoma classically tends toward lower reflectivity and acoustic hollowness.

No single sonographic feature should be used in isolation.

Chapter 06 • Case Study

Choroidal Hemangioma with Exudative Retinal Detachment

01Clinical History

Patient with visual decline and suspected serous/exudative retinal elevation. B-scan is requested to evaluate the choroidal mass and determine the extent of associated retinal detachment.

02Ultrasound Image

Figure 1. Choroidal hemangioma with associated exudative retinal detachment.

03Ultrasound Morphology

Feature	Sonographic Description
Choroidal lesion	Well-defined smooth acoustically solid mass.
Retinal detachment	Serous/exudative retinal elevation may surround or extend from the lesion.
Mobility	Assess the detached retina dynamically.
Vitreous	Evaluate for vitreous hemorrhage or other opacity that may limit fundus examination.
Calcification	No typical calcific shadowing is expected in a choroidal hemangioma.
Extent	Document retinal detachment distribution and macular involvement when visible.

04Ultrasound Report

Posterior choroidal mass with homogeneous relatively high-amplitude internal echoes and associated retinal elevation compatible with exudative retinal detachment. No definite intraocular calcific shadowing is demonstrated.

05Impression

Sonographic ImpressionChoroidal hemangioma with associated exudative retinal detachment.

06Recommendation

Ophthalmic evaluation with OCT and angiographic correlation is recommended to assess macular involvement and disease activity. Compare with previous ultrasound examinations when available.

07Learning Points

Exudative retinal detachment is a recognized complication of choroidal hemangioma.

The mass and retinal fluid should be described as separate sonographic components.

Dynamic B-scan helps assess the retinal detachment.

Ultrasound is useful when media opacity limits direct fundus visualization.

Chapter 07 • Case Study

Follow-Up Assessment of Choroidal Hemangioma

01Clinical History

Known choroidal hemangioma undergoing interval ultrasound assessment. The principal objectives are reproducible lesion measurement, comparison of contour and internal echotexture, and assessment of associated subretinal fluid or retinal detachment.

02Ultrasound Image

Figure 1. Follow-up B-scan assessment of known choroidal hemangioma.

03Ultrasound Morphology

Feature	Sonographic Description
Tumor thickness	Measure maximum apical height using a consistent scan plane.
Basal dimensions	Record comparable basal diameter measurements when possible.
Contour	Compare smooth dome/fusiform contour with previous examination.
Internal echoes	Assess for stability of homogeneous acoustic solidity.
Subretinal fluid	Document absent, stable, increased or decreased fluid.
Retinal detachment	Document presence, extent and mobility.

04Ultrasound Report

Known choroidal hemangioma demonstrates a smooth homogeneous acoustically solid choroidal lesion. Current measurements should be compared with the prior examination using similar scan planes. Associated subretinal fluid/retinal elevation is assessed separately.

05Impression

Sonographic ImpressionKnown choroidal hemangioma — interval sonographic assessment with documentation of lesion dimensions and associated retinal/subretinal changes.

06Recommendation

Continue ophthalmic follow-up according to the treating specialist's plan. Use consistent measurement technique and correlate with OCT/angiographic imaging when clinically indicated.

07Learning Points

Serial ultrasound is useful for objective size documentation when clinically indicated.

Measure the lesion consistently across examinations.

Track associated subretinal fluid as a separate outcome.

Interpret interval change with the complete clinical and multimodal imaging picture.

Key Sonographic Summary

Parameter	Typical Sonographic Finding
B-scan shape	Dome-shaped, fusiform or biconvex choroidal mass in circumscribed lesions.
Internal echotexture	Usually homogeneous.
A-scan reflectivity	Typically high internal reflectivity.
B-scan acoustic character	Acoustically solid, often similar to surrounding choroid.
Diffuse form	Generalized posterior choroidal thickening rather than a dominant discrete mass.
Associated finding	Subretinal fluid / exudative retinal detachment may occur.
Important differential	Amelanotic choroidal melanoma, metastasis and other choroidal masses.

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Choroidal Melanoma | B-Scan Eye Pathology

Diagnostic Sonography • B-Scan Eye Pathology Atlas

Choroidal Melanoma

A structured ocular ultrasound case collection covering dome-shaped, mushroom/collar-button, diffuse and complicated choroidal melanoma patterns, with emphasis on internal acoustic characteristics, tumor dimensions, associated retinal findings and possible extraocular extension.

OCULAR ULTRASOUNDB-SCANUVEA7 CASES

Choroidal Melanoma — Sonographic Morphology Index

01 Dome-Shaped Choroidal Melanoma →

02 Mushroom / Collar-Button Choroidal Melanoma →

03 Choroidal Melanoma with Subretinal Fluid →

04 Amelanotic Choroidal Melanoma →

05 Choroidal Melanoma with Vitreous Hemorrhage →

06 Choroidal Melanoma with Extrascleral Extension →

07 Diffuse / Flat Choroidal Melanoma →

Chapter 01 • Case Study

Dome-Shaped Choroidal Melanoma

01Clinical History

Patient referred for evaluation of a suspected posterior uveal mass with limited fundus visualization. B-scan is performed to define the lesion, measure its dimensions and assess internal acoustic characteristics.

02Ultrasound Image

Figure 1. B-scan appearance of dome-shaped choroidal melanoma.

03Ultrasound Morphology

Feature	Sonographic Description
Configuration	Well-defined elevated choroidal mass with a dome-shaped contour.
Internal reflectivity	Typically low to moderate internal reflectivity; correlation with A-scan is useful.
Acoustic profile	The lesion may demonstrate acoustic hollowness on B-scan.
Location	Arises from the choroid and may be posterior to the equator.
Measurements	Document apical height and largest basal dimensions.

04Ultrasound Report

A well-defined dome-shaped choroidal mass is demonstrated.

The lesion demonstrates relatively low internal acoustic reflectivity/hollowness.

Tumor dimensions should be documented in multiple planes.

05Impression

Sonographic ImpressionDome-shaped choroidal mass with low internal acoustic reflectivity/hollowness, suspicious for choroidal melanoma in the appropriate clinical setting.

06Recommendation

Ophthalmic oncology evaluation with multimodal ocular imaging. Serial measurements should use consistent imaging technique; MRI may be indicated when extraocular extension is suspected.

07Learning Points

Document apical height and largest basal dimensions using standardized planes.

Assess internal reflectivity and acoustic hollowness, with A-scan correlation when available.

Search systematically for subretinal fluid, retinal detachment, hemorrhage and scleral abnormalities.

Use multimodal imaging and specialist ophthalmic assessment; ultrasound alone does not establish histology.

Chapter 02 • Case Study

Mushroom / Collar-Button Choroidal Melanoma

01Clinical History

Patient with a prominent elevated choroidal lesion. Ultrasound is requested to characterize the contour and determine whether there is a mushroom or collar-button configuration.

02Ultrasound Image

Figure 1. B-scan appearance of mushroom/collar-button choroidal melanoma.

03Ultrasound Morphology

Feature	Sonographic Description
Configuration	Mushroom or collar-button contour may occur when the tumor extends through Bruch's membrane.
Base	A broad choroidal base with a narrower apical component may be seen.
Acoustic hollowness	Relative acoustic hollowness can be demonstrated within the mass.
Mobility	The tumor is attached to the ocular wall rather than behaving as a freely mobile retinal membrane.
Associated findings	Assess for subretinal fluid, retinal detachment and vitreous hemorrhage.

04Ultrasound Report

A choroidal mass demonstrates a mushroom/collar-button configuration.

The lesion is acoustically relatively hollow with a broad choroidal base.

Associated retinal or subretinal abnormalities should be documented.

05Impression

Sonographic ImpressionMushroom/collar-button choroidal mass with acoustic hollowness, a sonographic pattern strongly suggestive of uveal melanoma.

06Recommendation

Urgent ocular oncology assessment and multimodal imaging. MRI should be considered when assessment of scleral or extraocular extension is required.

07Learning Points

Document apical height and largest basal dimensions using standardized planes.

Assess internal reflectivity and acoustic hollowness, with A-scan correlation when available.

Search systematically for subretinal fluid, retinal detachment, hemorrhage and scleral abnormalities.

Use multimodal imaging and specialist ophthalmic assessment; ultrasound alone does not establish histology.

Chapter 03 • Case Study

Choroidal Melanoma with Subretinal Fluid

01Clinical History

Patient with visual symptoms and an elevated choroidal lesion. B-scan is performed to characterize the mass and evaluate associated subretinal fluid or exudative retinal detachment.

02Ultrasound Image

Figure 1. Choroidal melanoma with associated subretinal fluid on B-scan.

03Ultrasound Morphology

Feature	Sonographic Description
Tumor	Elevated choroidal mass with dome or mushroom configuration.
Subretinal fluid	Anechoic or low-level fluid may surround the tumor and produce associated retinal elevation.
Retinal detachment	Exudative retinal detachment may accompany a larger or active tumor.
Acoustic profile	The tumor may remain relatively hollow internally.
Extent	Document the circumferential and posterior extent of associated fluid.

04Ultrasound Report

A choroidal mass is demonstrated with associated subretinal fluid/exudative retinal detachment.

The tumor demonstrates a relatively low-reflectivity acoustic profile.

The extent of retinal elevation and fluid should be documented.

05Impression

Sonographic ImpressionChoroidal mass with associated subretinal fluid/exudative retinal detachment; findings are suspicious for choroidal melanoma.

06Recommendation

Ophthalmic oncology evaluation with multimodal imaging and standardized tumor measurements.

07Learning Points

Document apical height and largest basal dimensions using standardized planes.

Assess internal reflectivity and acoustic hollowness, with A-scan correlation when available.

Search systematically for subretinal fluid, retinal detachment, hemorrhage and scleral abnormalities.

Use multimodal imaging and specialist ophthalmic assessment; ultrasound alone does not establish histology.

Chapter 04 • Case Study

Amelanotic Choroidal Melanoma

01Clinical History

Patient with an elevated choroidal lesion without obvious dark pigmentation on clinical examination. Ultrasound is used to characterize the mass and internal acoustic features.

02Ultrasound Image

Figure 1. B-scan appearance of amelanotic choroidal melanoma.

03Ultrasound Morphology

Feature	Sonographic Description
Pigmentation	Absence of visible pigmentation does not exclude melanoma.
Configuration	Usually dome-shaped, although mushroom or diffuse configurations may occur.
Internal reflectivity	Often relatively low to moderate internal reflectivity.
Acoustic profile	Acoustic hollowness may be present.
Differential	Choroidal metastasis, hemangioma and other choroidal lesions may overlap; multimodal imaging is required.

04Ultrasound Report

A solid dome-shaped choroidal mass is demonstrated.

The lesion shows relatively low internal acoustic reflectivity.

No sonographic feature alone establishes histologic diagnosis.

05Impression

Sonographic ImpressionChoroidal mass with sonographic characteristics compatible with a melanocytic tumor; amelanotic melanoma should be considered in the appropriate clinical setting.

06Recommendation

Specialist ophthalmic assessment with multimodal imaging to distinguish melanoma from other choroidal masses.

07Learning Points

Document apical height and largest basal dimensions using standardized planes.

Assess internal reflectivity and acoustic hollowness, with A-scan correlation when available.

Search systematically for subretinal fluid, retinal detachment, hemorrhage and scleral abnormalities.

Use multimodal imaging and specialist ophthalmic assessment; ultrasound alone does not establish histology.

Chapter 05 • Case Study

Choroidal Melanoma with Vitreous Hemorrhage

01Clinical History

Patient with visual loss and poor fundus visualization due to vitreous hemorrhage. B-scan is performed to identify an underlying mass and assess the vitreous and retina.

02Ultrasound Image

Figure 1. Choroidal melanoma associated with vitreous hemorrhage on B-scan.

03Ultrasound Morphology

Feature	Sonographic Description
Mass	Choroidal mass may remain visible despite overlying vitreous hemorrhage.
Vitreous	Mobile or layered internal echoes may represent hemorrhage.
Dynamic examination	The hemorrhagic echoes may move differently from the attached tumor.
Tumor profile	Assess for dome/mushroom configuration and acoustic hollowness.
Retina	Evaluate for associated retinal detachment.

04Ultrasound Report

A choroidal mass is identified beneath/adjacent to vitreous echogenic material.

The vitreous echoes demonstrate mobility compatible with hemorrhagic material.

The underlying tumor should be characterized separately from the vitreous findings.

05Impression

Sonographic ImpressionChoroidal mass associated with vitreous hemorrhagic echoes; choroidal melanoma should be considered when the mass demonstrates typical uveal tumor characteristics.

06Recommendation

Urgent ophthalmic evaluation and multimodal imaging after characterization of the underlying lesion.

07Learning Points

Document apical height and largest basal dimensions using standardized planes.

Assess internal reflectivity and acoustic hollowness, with A-scan correlation when available.

Search systematically for subretinal fluid, retinal detachment, hemorrhage and scleral abnormalities.

Use multimodal imaging and specialist ophthalmic assessment; ultrasound alone does not establish histology.

Chapter 06 • Case Study

Choroidal Melanoma with Extrascleral Extension

01Clinical History

Patient with a known or suspected choroidal melanoma. Ultrasound is performed to evaluate the tumor and assess the scleral contour and adjacent orbital tissues.

02Ultrasound Image

Figure 1. Choroidal melanoma with suspected extrascleral extension on ultrasound.

03Ultrasound Morphology

Feature	Sonographic Description
Primary mass	Elevated choroidal mass with typical dome or mushroom configuration.
Scleral interface	Assess the normal reflective scleral boundary adjacent to the tumor.
Extrascleral component	Abnormal tissue extending beyond the expected scleral contour may suggest extrascleral extension.
Orbital tissue	The relationship between the lesion and orbital fat should be assessed.
Limitation	MRI provides complementary soft-tissue assessment and is often preferred when extension is suspected.

04Ultrasound Report

A choroidal mass is demonstrated with focal abnormality at the scleral interface.

A possible extraocular soft-tissue component is noted beyond the expected scleral contour.

The finding requires correlation with dedicated orbital imaging.

05Impression

Sonographic ImpressionChoroidal mass with suspected extrascleral extension; dedicated orbital MRI correlation is recommended.

06Recommendation

Urgent ocular oncology assessment and MRI of the orbits when extraocular extension is suspected.

07Learning Points

Document apical height and largest basal dimensions using standardized planes.

Assess internal reflectivity and acoustic hollowness, with A-scan correlation when available.

Search systematically for subretinal fluid, retinal detachment, hemorrhage and scleral abnormalities.

Use multimodal imaging and specialist ophthalmic assessment; ultrasound alone does not establish histology.

Chapter 07 • Case Study

Diffuse / Flat Choroidal Melanoma

01Clinical History

Patient with a broad choroidal abnormality and subtle fundus findings. B-scan is performed to assess the extent and thickness of a relatively flat or diffuse uveal lesion.

02Ultrasound Image

Figure 1. Diffuse or relatively flat choroidal melanoma on B-scan.

03Ultrasound Morphology

Feature	Sonographic Description
Configuration	Diffuse or relatively flat choroidal thickening may occur rather than a prominent dome.
Extent	The lesion may have a broad basal distribution with comparatively low height.
Internal reflectivity	Internal acoustic characteristics may overlap with other melanocytic lesions.
Localization	Multiplanar scanning helps define the involved choroidal region.
Differential	Diffuse melanoma may overlap with metastasis, hemangioma and inflammatory or other choroidal processes.

04Ultrasound Report

Broad choroidal thickening/elevation is demonstrated.

The lesion has a relatively flat or diffuse configuration.

Multimodal imaging is required for characterization and comparison over time.

05Impression

Sonographic ImpressionDiffuse choroidal lesion with relatively flat configuration; choroidal melanoma remains a diagnostic consideration and requires multimodal correlation.

06Recommendation

Ophthalmic oncology assessment with standardized multimodal imaging and follow-up measurements.

07Learning Points

Document apical height and largest basal dimensions using standardized planes.

Assess internal reflectivity and acoustic hollowness, with A-scan correlation when available.

Search systematically for subretinal fluid, retinal detachment, hemorrhage and scleral abnormalities.

Use multimodal imaging and specialist ophthalmic assessment; ultrasound alone does not establish histology.

Educational References

1. AAO EyeWiki — Echography (Ultrasound)
2. AAO EyeWiki — Choroidal and Ciliary Body Melanoma
3. Imaging of Uveal Melanoma — Current Standard and Methods in Development

Educational note: B-scan findings should be interpreted with ophthalmic examination and multimodal imaging. Acoustic hollowness and tumor configuration are supportive findings rather than standalone proof of malignancy; benign melanocytic lesions can overlap sonographically.

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Retinoblastoma | B-Scan Eye Pathology

Diagnostic Sonography • B-Scan Eye Pathology Atlas

Retinoblastoma

A structured ocular ultrasound case collection covering sonographically recognizable retinoblastoma patterns, with emphasis on intraocular mass morphology, calcification, retinal involvement, vitreous abnormalities and associated retinal detachment.

OCULAR ULTRASOUNDB-SCANRETINA7 CASES

Retinoblastoma — Sonographic Morphology Index

01 Classic Calcified Intraocular Retinoblastoma →

02 Endophytic Retinoblastoma →

03 Exophytic Retinoblastoma with Subretinal Fluid →

04 Retinoblastoma with Extensive Vitreous Seeding →

05 Retinoblastoma with Retinal Detachment →

06 Extensive Retinoblastoma with Near-Total Globe Involvement →

07 Retinoblastoma — Sonographic Assessment for Local Extension →

Chapter 01 • Case Study

Classic Calcified Intraocular Retinoblastoma

01Clinical History

Child referred for evaluation of leukocoria with limited fundus visualization. B-scan is performed to identify an intraocular mass, characterize internal reflectivity and assess for calcification.

02Ultrasound Image

Figure 1. B-scan appearance of an intraocular retinoblastoma with highly reflective calcific foci.

03Ultrasound Morphology

Feature	Sonographic Description
Mass	Solid intraocular mass, typically more echogenic than the vitreous.
Reflectivity	Focal very high reflectivity may correspond to intratumoral calcification.
Calcification	Highly reflective foci with posterior acoustic shadowing strongly support retinoblastoma in a child.
Location	Often arises from the retina and may project into the vitreous cavity.
Assessment	Document tumor dimensions and examine the remainder of the globe for associated retinal detachment or other abnormalities.

04Ultrasound Report

A solid intraocular mass is demonstrated.

Multiple highly reflective intralesional foci with posterior acoustic shadowing are identified, compatible with calcification.

The sonographic appearance is highly suspicious for retinoblastoma in the appropriate clinical setting.

05Impression

Sonographic ImpressionIntraocular mass with intralesional calcific foci — sonographic appearance highly suspicious for retinoblastoma.

06Recommendation

Urgent ophthalmic oncology evaluation with comprehensive ocular examination and appropriate staging imaging, including MRI when indicated.

07Learning Points

Document the tumor location, configuration and dimensions systematically.

Look specifically for intratumoral calcification and posterior acoustic shadowing.

Assess the vitreous and retina for associated abnormalities.

Do not use B-scan alone to exclude optic nerve or extraocular extension.

Chapter 02 • Case Study

Endophytic Retinoblastoma

01Clinical History

Child with suspected posterior segment tumor. B-scan is obtained to characterize a mass projecting toward the vitreous and to evaluate for associated vitreous or subretinal abnormalities.

02Ultrasound Image

Figure 1. Sonographic appearance of an endophytic intraocular tumor projecting toward the vitreous.

03Ultrasound Morphology

Feature	Sonographic Description
Configuration	Retinal-based mass projecting inward toward the vitreous cavity.
Echogenicity	Usually echogenic relative to the vitreous.
Calcification	Internal hyperreflective foci may be present and can produce posterior shadowing.
Vitreous	Evaluate for echogenic material that may represent vitreous seeds, while recognizing that ultrasound cannot replace ophthalmic examination.
Extent	Document the tumor base, height and relationship to the posterior pole.

04Ultrasound Report

A retinal-based intraocular mass projects toward the vitreous cavity.

Internal high-reflectivity foci are present; calcification should be correlated with the ultrasound appearance.

The vitreous cavity and remaining retina should be evaluated for associated abnormalities.

05Impression

Sonographic ImpressionRetinal-based intraocular mass with endophytic configuration; retinoblastoma is a major diagnostic consideration.

06Recommendation

Urgent specialist ophthalmic assessment with examination under anesthesia when clinically indicated and MRI for assessment of local extension.

07Learning Points

Document the tumor location, configuration and dimensions systematically.

Look specifically for intratumoral calcification and posterior acoustic shadowing.

Assess the vitreous and retina for associated abnormalities.

Do not use B-scan alone to exclude optic nerve or extraocular extension.

Chapter 03 • Case Study

Exophytic Retinoblastoma with Subretinal Fluid

01Clinical History

Child with leukocoria and suspected posterior retinal tumor. B-scan is performed because fundus visualization is limited and to assess the relationship between the tumor and subretinal space.

02Ultrasound Image

Figure 1. Exophytic retinal mass with associated subretinal fluid on B-scan.

03Ultrasound Morphology

Feature	Sonographic Description
Configuration	Tumor grows outward from the retina toward the subretinal space.
Subretinal fluid	Associated subretinal fluid or exudative retinal detachment may be demonstrated.
Calcification	Calcific foci may be present and are an important sonographic clue.
Retina	Assess the extent of associated retinal detachment and residual attached retina.
Differential	Coats disease and other causes of leukocoria may mimic some features; clinical correlation is essential.

04Ultrasound Report

A retinal-based intraocular mass is demonstrated with associated subretinal fluid.

Internal reflective foci are present and should be assessed for calcification.

The findings require correlation with ophthalmic examination and dedicated imaging.

05Impression

Sonographic ImpressionRetinal-based intraocular mass with associated subretinal fluid/exudative retinal detachment; retinoblastoma should be urgently excluded.

06Recommendation

Prompt referral to an ocular oncology service. MRI is useful for evaluation of local extension when indicated.

07Learning Points

Document the tumor location, configuration and dimensions systematically.

Look specifically for intratumoral calcification and posterior acoustic shadowing.

Assess the vitreous and retina for associated abnormalities.

Do not use B-scan alone to exclude optic nerve or extraocular extension.

Chapter 04 • Case Study

Retinoblastoma with Extensive Vitreous Seeding

01Clinical History

Child with suspected retinoblastoma and extensive vitreous abnormality. Dynamic B-scan is used to assess the globe when the tumor or vitreous cannot be adequately evaluated clinically.

02Ultrasound Image

Figure 1. Intraocular tumor with associated echogenic vitreous material.

03Ultrasound Morphology

Feature	Sonographic Description
Primary mass	Identify the underlying retinal-based mass whenever visible.
Vitreous echoes	Multiple echogenic foci or particulate material may be seen within the vitreous.
Calcification	Calcification within the primary tumor remains an important diagnostic clue.
Mobility	Vitreous echoes may show different movement from the solid tumor; dynamic assessment can help characterize the pattern.
Limitation	Ultrasound cannot reliably characterize or grade vitreous seeds; ophthalmic examination remains essential.

04Ultrasound Report

A retinal-based intraocular mass is demonstrated with associated echogenic vitreous material.

Internal reflective foci within the mass are noted.

The sonographic findings are concerning for retinoblastoma with associated vitreous abnormality.

05Impression

Sonographic ImpressionIntraocular mass with associated vitreous echogenic material, concerning for retinoblastoma with vitreous seeding.

06Recommendation

Urgent ocular oncology evaluation and comprehensive retinal examination. Management and disease classification should be based on specialist ophthalmic assessment.

07Learning Points

Document the tumor location, configuration and dimensions systematically.

Look specifically for intratumoral calcification and posterior acoustic shadowing.

Assess the vitreous and retina for associated abnormalities.

Do not use B-scan alone to exclude optic nerve or extraocular extension.

Chapter 05 • Case Study

Retinoblastoma with Retinal Detachment

01Clinical History

Child with advanced ocular symptoms and poor fundus visualization. B-scan is performed to characterize the tumor and determine the presence and extent of associated retinal detachment.

02Ultrasound Image

Figure 1. Intraocular tumor with associated retinal detachment on B-scan.

03Ultrasound Morphology

Feature	Sonographic Description
Tumor	Solid intraocular retinal-based mass.
Retinal detachment	Separate elevated retinal membrane or complex subretinal fluid may be demonstrated.
Mobility	The detached retinal component may demonstrate dynamic mobility distinct from the tumor.
Calcification	Intratumoral calcification may be identified as highly reflective foci with shadowing.
Extent	Document the extent of detachment and whether the posterior pole is involved.

04Ultrasound Report

A solid intraocular mass is demonstrated.

Associated retinal detachment/subretinal fluid is identified.

Intralesional reflective foci are present and should be correlated for calcification.

05Impression

Sonographic ImpressionIntraocular mass with associated retinal detachment; findings are concerning for retinoblastoma in the appropriate clinical setting.

06Recommendation

Urgent ophthalmic oncology assessment. MRI should be considered for evaluation of optic nerve, orbital and intracranial extension when clinically indicated.

07Learning Points

Document the tumor location, configuration and dimensions systematically.

Look specifically for intratumoral calcification and posterior acoustic shadowing.

Assess the vitreous and retina for associated abnormalities.

Do not use B-scan alone to exclude optic nerve or extraocular extension.

Chapter 06 • Case Study

Extensive Retinoblastoma with Near-Total Globe Involvement

01Clinical History

Child with markedly abnormal ocular appearance and inadequate fundus visualization. B-scan is performed to define the intraocular tumor burden and evaluate associated retinal or vitreous abnormalities.

02Ultrasound Image

Figure 1. Extensive intraocular tumor burden on B-scan.

03Ultrasound Morphology

Feature	Sonographic Description
Extent	Large intraocular mass occupying a substantial portion of the globe.
Reflectivity	Heterogeneous internal reflectivity may be present.
Calcification	Multiple hyperreflective calcific foci may be conspicuous.
Vitreous	Assess for associated echogenic material and hemorrhagic change.
Retina	Evaluate for retinal detachment and residual attached retina.

04Ultrasound Report

Large heterogeneous intraocular mass occupying a substantial portion of the globe is demonstrated.

Multiple highly reflective intralesional foci are identified.

Associated retinal and vitreous abnormalities should be assessed on all available views.

05Impression

Sonographic ImpressionExtensive intraocular mass with internal hyperreflective foci, highly concerning for retinoblastoma.

06Recommendation

Urgent multidisciplinary ocular oncology evaluation with comprehensive clinical examination and MRI-based assessment of local extension when indicated.

07Learning Points

Document the tumor location, configuration and dimensions systematically.

Look specifically for intratumoral calcification and posterior acoustic shadowing.

Assess the vitreous and retina for associated abnormalities.

Do not use B-scan alone to exclude optic nerve or extraocular extension.

Chapter 07 • Case Study

Retinoblastoma — Sonographic Assessment for Local Extension

01Clinical History

Known or strongly suspected retinoblastoma undergoing imaging assessment. B-scan is used to document intraocular tumor morphology, while MRI is used when evaluation of optic nerve, orbital or intracranial extension is required.

02Ultrasound Image

Figure 1. B-scan documentation of intraocular retinoblastoma before dedicated staging assessment.

03Ultrasound Morphology

Feature	Sonographic Description
Intraocular tumor	Document location, dimensions, configuration and internal reflectivity.
Calcification	Identify hyperreflective foci and posterior acoustic shadowing.
Optic nerve	B-scan is not the preferred modality for definitive assessment of optic nerve invasion.
Orbit	Extraocular extension should not be excluded by a reassuring B-scan alone.
MRI correlation	MRI provides superior soft-tissue assessment of optic nerve, orbital and intracranial extension.

04Ultrasound Report

Intraocular mass consistent with the known/suspected retinoblastoma is demonstrated.

Internal hyperreflective foci are documented.

Ultrasound findings should be correlated with ophthalmic examination and MRI when local extension assessment is required.

05Impression

Sonographic ImpressionSonographic documentation of intraocular retinoblastoma; ultrasound findings should be integrated with specialist ophthalmic examination and MRI for local staging when indicated.

06Recommendation

Refer to a specialized ocular oncology team. MRI is preferred for assessment of optic nerve and extraocular/intracranial extension.

07Learning Points

Document the tumor location, configuration and dimensions systematically.

Look specifically for intratumoral calcification and posterior acoustic shadowing.

Assess the vitreous and retina for associated abnormalities.

Do not use B-scan alone to exclude optic nerve or extraocular extension.

Educational Imaging References

This atlas uses the same visual structure as the supplied SonoAcademy Retinoschisis template, while the Retinoblastoma-specific medical content has been expanded from current ophthalmic imaging references.

1. American Academy of Ophthalmology EyeWiki — Retinoblastoma
2. 2025 Practical Guidelines on Imaging of Retinoblastoma
3. Retinoblastoma: What the Neuroradiologist Needs to Know

Educational note: B-scan findings should be interpreted with ophthalmic examination and appropriate MRI/staging evaluation. Ultrasound alone should not be used to exclude optic nerve or extraocular extension.

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