Diagnostic Sonography • B-Scan Eye Pathology Atlas
Choroidal Tumors
A structured ocular ultrasound case collection covering sonographically recognizable choroidal tumor patterns, with emphasis on lesion location, configuration, internal echoes, mobility, extent and associated posterior-segment findings.
Choroidal Tumors — Sonographic Morphology Index
01Choroidal Melanoma→
02Choroidal Hemangioma→
03Choroidal Metastasis→
04Choroidal Osteoma→
05Choroidal Lymphoma→
06Choroidal Schwannoma→
07Choroidal Leiomyoma→
Chapter 01 • Case Study
Choroidal Melanoma
01Clinical History
Patient with progressive visual disturbance, photopsia, floaters, or visual-field symptoms. Fundus visualization may be limited, making B-scan useful for characterization of a suspected choroidal mass.
02Ultrasound Image
03Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Location | Choroidal-based lesion, commonly posterior or peripheral. |
| Configuration | Focal solid mass, often dome-shaped; larger lesions may show mushroom/collar-button configuration. |
| Internal echoes | Usually medium-to-low internal reflectivity with variable homogeneity. |
| Mobility | Solid lesion demonstrates limited mobility compared with freely mobile vitreous material. |
| Associated findings | Assess for subretinal fluid, exudative retinal detachment, vitreous hemorrhage and other secondary changes. |
04Ultrasound Report
B-scan demonstrates a focal solid choroidal mass with smooth dome-shaped / mushroom-like contour and limited mobility. Associated retinal and subretinal findings should be assessed.
05Impression
Sonographic ImpressionSonographic appearance is compatible with a choroidal tumor and is suspicious for choroidal melanoma in the appropriate clinical setting.
06Recommendation
Comprehensive ophthalmic examination and ocular oncology assessment with multimodal ocular imaging as clinically indicated. Document lesion dimensions, location and associated retinal findings.
07Learning Points
Recognize a solid choroidal mass and distinguish it from mobile vitreous pathology.
Dome-shaped and mushroom/collar-button configurations are important patterns.
Measure the lesion in multiple planes and document its location.
Assess systematically for subretinal fluid, retinal detachment and vitreous hemorrhage.
Chapter 02 • Case Study
Choroidal Hemangioma
01Clinical History
Patient may present with decreased vision, metamorphopsia, photopsia, or symptoms related to subretinal fluid. Direct fundus visualization may be limited by media opacity.
02Ultrasound Image
03Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Location | Choroidal lesion, often involving the posterior pole or juxtapapillary region in circumscribed lesions. |
| Configuration | Smooth, broad-based, dome-shaped or lentiform elevation. |
| Internal echoes | Generally relatively homogeneous with medium-to-high internal reflectivity. |
| Mobility | Solid lesion with minimal internal mobility; Doppler may demonstrate vascular flow when technically feasible. |
| Associated findings | Subretinal fluid and secondary retinal changes may occur. |
04Ultrasound Report
B-scan demonstrates a well-circumscribed smooth choroidal elevation with relatively homogeneous internal echoes and limited mobility. Associated subretinal fluid should be assessed.
05Impression
Sonographic ImpressionSonographic appearance is compatible with a choroidal hemangioma in the appropriate clinical setting.
06Recommendation
Correlate with ophthalmic examination and multimodal ocular imaging. Doppler assessment may be considered when technically feasible and clinically indicated.
07Learning Points
A smooth, well-defined solid choroidal elevation is a key pattern.
Internal reflectivity may assist differential characterization.
Look carefully for associated subretinal fluid.
Record lesion size and precise location for follow-up.
Chapter 03 • Case Study
Choroidal Metastasis
01Clinical History
Patient with known or suspected systemic malignancy may present with decreased vision, photopsia, scotoma, or other ocular symptoms. Lesions may be multifocal or bilateral.
02Ultrasound Image
03Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Location | Choroidal-based lesion, frequently posterior; additional lesions may be present. |
| Configuration | Smooth, relatively broad-based or placoid elevation. |
| Internal echoes | Often relatively homogeneous and moderately reflective, with variable appearance. |
| Distribution | May be solitary, multifocal or bilateral; systematic examination is important. |
| Associated findings | Subretinal fluid and exudative retinal detachment may occur. |
04Ultrasound Report
B-scan demonstrates a focal choroidal-based solid elevation with smooth contour and limited mobility. Additional focal lesions and associated subretinal fluid should be assessed.
05Impression
Sonographic ImpressionSonographic appearance is compatible with a choroidal mass; metastatic disease should be considered particularly with known or suspected systemic malignancy.
06Recommendation
Prompt ophthalmic assessment with systemic clinical correlation. Coordinate appropriate oncologic evaluation and multimodal ocular imaging when indicated.
07Learning Points
Consider metastasis when choroidal masses are multifocal or bilateral.
A smooth broad-based choroidal elevation may be seen.
Examine the entire posterior segment and both eyes when clinically appropriate.
Systemic history is important for interpretation.
Chapter 04 • Case Study
Choroidal Osteoma
01Clinical History
Patient may present with decreased central vision, metamorphopsia, or other visual symptoms. Ultrasound can demonstrate mineralization when direct fundus assessment is limited.
02Ultrasound Image
03Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Location | Typically juxtapapillary or peripapillary and may extend toward the macula. |
| Configuration | Well-defined elevated or plaque-like choroidal lesion. |
| Internal echoes | Markedly echogenic because of dense calcified/ossified components. |
| Acoustic behavior | Strong posterior acoustic shadowing may occur due to mineralized tissue. |
| Associated findings | Retinal or subretinal changes depend on lesion location and activity. |
04Ultrasound Report
B-scan demonstrates a well-defined highly echogenic choroidal-based lesion with strong acoustic reflectivity and posterior shadowing, compatible with a mineralized choroidal lesion.
05Impression
Sonographic ImpressionSonographic appearance is compatible with choroidal osteoma in the appropriate clinical setting.
06Recommendation
Correlate with fundus examination and multimodal ocular imaging. Document lesion location and extent, particularly in relation to the optic disc and macula.
07Learning Points
Strong echogenicity with posterior shadowing suggests mineralization.
Document the relationship to the optic disc and macula.
Use multiple scan planes to establish lesion origin.
Correlate ultrasound with multimodal imaging.
Chapter 05 • Case Study
Choroidal Lymphoma
01Clinical History
Patient may present with gradual visual decline, subretinal fluid, or nonspecific ocular symptoms. Ultrasound may demonstrate diffuse choroidal thickening when direct examination is limited.
02Ultrasound Image
03Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Location | Choroidal-based process, often involving a broad region rather than a sharply circumscribed solitary mass. |
| Configuration | Smooth, diffuse, placoid or gently elevated choroidal thickening. |
| Internal echoes | Relatively homogeneous internal reflectivity may be seen. |
| Distribution | May be multifocal or diffuse; bilateral assessment may be clinically appropriate. |
| Associated findings | Subretinal fluid and retinal changes may accompany the process. |
04Ultrasound Report
B-scan demonstrates smooth diffuse choroidal thickening/elevation with relatively homogeneous internal echoes and limited mobility. The appearance is choroidal-based rather than a freely mobile vitreous lesion.
05Impression
Sonographic ImpressionSonographic appearance is compatible with diffuse choroidal thickening; choroidal lymphoma may be considered in the appropriate clinical context.
06Recommendation
Ophthalmic and systemic evaluation with multimodal ocular imaging. Correlate with oncologic history and specialist assessment.
07Learning Points
Diffuse smooth choroidal thickening differs from a discrete dome-shaped mass.
Assess the full circumference of the globe when diffuse disease is suspected.
Subretinal fluid may be associated.
Systemic and ophthalmic context is important for differential diagnosis.
Chapter 06 • Case Study
Choroidal Schwannoma
01Clinical History
Patient may present with progressive visual symptoms or an incidentally detected intraocular mass. Clinical examination may be limited by lesion location or media opacity.
02Ultrasound Image
03Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Location | Choroidal/ciliary-region solid mass, often peripheral or posterior. |
| Configuration | Well-circumscribed, smooth, dome-shaped or oval solid elevation. |
| Internal echoes | Variable internal reflectivity with a solid appearance. |
| Mobility | Limited mobility with attachment to the ocular wall; no free vitreous mobility. |
| Associated findings | Subretinal fluid or secondary retinal changes may occur depending on size and location. |
04Ultrasound Report
B-scan demonstrates a well-defined solid choroidal-region mass with smooth contour and limited mobility. The lesion is distinct from freely mobile vitreous echoes.
05Impression
Sonographic ImpressionSonographic appearance is compatible with a solid choroidal-region tumor; choroidal schwannoma may be considered in the appropriate clinical setting.
06Recommendation
Ophthalmic tumor evaluation with multimodal imaging and clinical correlation. Histopathologic confirmation may be required when clinically indicated.
07Learning Points
Rare choroidal tumors can mimic more common solid intraocular masses.
Establish the lesion's choroidal/ciliary origin.
Document size, contour and relationship to adjacent structures.
Ultrasound morphology alone does not establish histologic subtype.
Chapter 07 • Case Study
Choroidal Leiomyoma
01Clinical History
Patient may present with slowly progressive visual disturbance or an incidentally identified ocular mass. Symptoms and fundus visibility depend on lesion size and location.
02Ultrasound Image
03Ultrasound Morphology
| Feature | Sonographic Description |
|---|---|
| Location | Localized choroidal/ciliary-region mass that may be peripheral or posterior. |
| Configuration | Smooth, well-circumscribed, dome-shaped solid elevation. |
| Internal echoes | Variable solid internal echoes with limited mobility. |
| Mobility | No free vitreous mobility; lesion remains attached to the ocular wall. |
| Associated findings | Subretinal fluid or secondary retinal displacement may occur with larger lesions. |
04Ultrasound Report
B-scan demonstrates a smooth, well-defined solid choroidal-region mass with limited mobility and attachment to the ocular wall. Associated retinal and subretinal abnormalities should be documented.
05Impression
Sonographic ImpressionSonographic appearance is compatible with a solid choroidal-region neoplasm; choroidal leiomyoma may be considered in the appropriate clinical setting.
06Recommendation
Refer for ophthalmic tumor assessment and multimodal imaging. Correlate with clinical examination and consider tissue diagnosis when clinically indicated.
07Learning Points
Distinguish a wall-based solid mass from vitreous lesions.
Document lesion dimensions and exact ocular location.
Assess the retina and subretinal space for secondary effects.
Rare tumor subtypes cannot be diagnosed by ultrasound morphology alone.
×![Ultrasound enlarged image]()
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