The suboptimal role of optical coherence tomography in diagnosing choroidal metastasis in the macula

Purpose: To describe the clinical, optical coherence tomography, and echographic findings of a choroidal metastasis in the macula. An initial, erroneous diagnosis of a serous pigment epithelial detachment of the macula had been based on ophthalmoscopic and optical coherence tomography findings. Methods: Case report of a patient with blurred vision in one eye and presumed serous pigment epithelial detachment. Results: An 83-year-old man with blurred vision and presumed serous pigment epithelial detachment was self-referred to our clinic for a second opinion. Optical coherence tomography showed an elevation of the neurosensory macula, but no abnormalities were reflected from the choroid. We performed an ultrasound evaluation, which revealed a solid mass involving the macular region of the choroid. The echographic characteristics, including low internal reflectivity, regular structure, and vascularity, were consistent with choroidal melanoma or metastasis from any small cell carcinoma. The patient was not aware of any active primary tumor. An extensive systemic workup was performed. His prostate-specific antigen was found to be elevated to 61.4 ng/mL, and a prostate biopsy was positive for adenocarcinoma. Additional studies revealed metastatic disease involving the bones, pulmonary parenchyma, and mediastinal and retroperitoneal lymph nodes. Conclusion: Ultrasound imaging was superior to optical coherence tomography imaging in the clinical setting of a choroidal mass in the macula.