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.
Choroidal Melanoma — Sonographic Morphology Index
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
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
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
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
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
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
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
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
- AAO EyeWiki — Echography (Ultrasound)
- AAO EyeWiki — Choroidal and Ciliary Body Melanoma
- 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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