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.
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
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
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
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
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
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
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
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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