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Year : 2022  |  Volume : 2  |  Issue : 3  |  Page : 828-829

A curious case of choroidal nodule in hypertensive choroidopathy


Department of Uveitis and Ocular Inflammation, Vittala International Institute of Ophthalmology and Prabha Eye Clinic and Research Centre, Bangalore, Karnataka, India

Date of Submission31-Jan-2022
Date of Acceptance15-Mar-2022
Date of Web Publication16-Jul-2022

Correspondence Address:
Dr. Kalpana Babu
Prabha Eye Clinic and Research Centre, 504, 40th Cross, Jayanagar 8th Block, Bangalore - 560 070, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_311_22

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  Abstract 


Keywords: Choroidal nodule, hypertension, hypertensive choroidopathy, optical coherence tomography


How to cite this article:
Konana VK, Babu K. A curious case of choroidal nodule in hypertensive choroidopathy. Indian J Ophthalmol Case Rep 2022;2:828-9

How to cite this URL:
Konana VK, Babu K. A curious case of choroidal nodule in hypertensive choroidopathy. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 11];2:828-9. Available from: https://www.ijoreports.in/text.asp?2022/2/3/828/351176



A 35-year-old-male presented with complaints of poor vision in the left eye (OS) for four days. Systemic history was not contributory. His best corrected visual acuity (BCVA) was 6/6 and 6/9 in right eye (OD) and left eye (OS), respectively. Anterior segment examination of both eyes (OU) was normal. Fundus examination in OD revealed few drusen-like deposits in the posterior pole; OS showed subretinal yellowish elevated choroidal nodular lesions resembling choroidal granuloma [Figure 1]a and [Figure 1]b with subretinal fluid (SRF) at the macula. Optical coherence tomography (OCT) in OD showed pigment epithelial detachment with localized SRF superior to fovea [Figure 1]c. OCT in OS over the yellowish choroidal lesion superior to fovea showed irregular retinal pigment epithelium (RPE), focal choroidal elevation, and SRF [Figure 1]d. Hypertensive retinopathy changes were noted in OU. Blood pressure (BP) recorded was 230/120 mmHg and patient was referred to a physician. Indocyanine green angiography showed choroidal hypoperfusion with staining of choroidal vasculature in OU [Figure 2]a and [Figure 2]b. After four days, with BP at 140/80 mmHg with antihypertensive medications, patient noticed improvement in OS vision. His BCVA was 6/6 (OU). Disappearance of drusen-like deposits (OD), decrease in the yellow choroidal nodules and subretinal fluid (OS) were noted on follow-up. [Figure 2]c, [Figure 2]d, [Figure 2]e.
Figure 1: (a) Fundus photograph of OD showing drusen-like deposit at macula (dotted circle) with arteriolar narrowing and arteriovenous crossing (AV) changes; (b) fundus photograph of OS showing sub retinal fluid at the macula with subretinal yellowish choroidal lesions with arteriolar narrowing and AV crossing changes; (c) OCT of OD over the yellowish lesions (dotted circle) showing pigment epithelial detachment with localized SRF; (d) OCT over the yellowish choroidal lesion in OS (dotted line) superior to fovea showing irregular retinal pigment epithelium, choroidal elevation, enlarged choroidal vessels, SRF

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Figure 2: (a and b) Indocyanine green angiography showing choroidal hypoperfusion with staining of choroidal vasculature in late phase in both eyes; (c) fundus photograph of right eye after reduction in blood pressure revealed that the drusen-like deposits superior to fovea had disappeared; (d) fundus photograph of left eye showing yellowish subretinal deposits had decreased with significant decrease in subretinal fluid at the fovea; (e) OCT over the area of focal choroidal elevation superior to fovea showing significant decrease in the elevation with minimal SRF

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  Discussion Top


Hypertensive choroidopathy (HC) occurs in young patients with malignant hypertension and can rarely present as focal choroidal elevations mimicking a choroidal nodule or granuloma. Elevated BP results in fibrinoid necrosis of the arterioles, non-perfusion of the choriocapillaris due to contraction of flexible vessels, leading to hypoperfusion.[1] This alters the RPE, causes outer retinal alterations, and SRF accumulation.[2],[3]

This case highlights that hypertension could be an important non-malignant masquerade.

In our case, points to differentiate focal choroidal elevation of HC from that of secondary to inflammation were (a) absence of vitreous cells and disc hyperemia, (b) presence of hypertensive retinopathy changes (c) absence of hypertransmission on OCT usually seen in choroidal granulomas as reported by Invernizzi et al.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kishi S, Tso MO, Hayreh SS. Fundus lesions in malignant hypertension. I. A pathologic study of experimental hypertensive choroidopathy. Arch Ophthalmol 1985;103:1189-97.  Back to cited text no. 1
    
2.
Stern WH, Ernest JT. Microsphere occlusion of the choriocapillaris in rhesus monkeys. Am J Ophthalmol 1974;78:438-48.  Back to cited text no. 2
    
3.
Gaudric A, Sterkers M, Coscas G. Retinal detachment after choroidal ischemia. Am J Ophthalmol 1987;104:364-72.  Back to cited text no. 3
    
4.
Invernizzi A, Mapelli C, Viola F, Cigada M, Cimino L, Ratiglia R, et al. Choroidal granulomas visualized by enhanced depth imaging optical coherence tomography. Retina 2015;35:525-31.  Back to cited text no. 4
    


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