Title

Differential diagnosis for subretinal yellowish lesions: metastasis versus sclerochoroidal calcifications

Introduction

To report a case of sclerochoroidal calcifications in an 80-year-old man

Methods

Case report and correlation to literature

Results

Male, 80 yo, in treatment for prostate cancer, asymptomatic. Best corrected visual acuity was 20/30 in both eyes. Anterior segment exam was unremarkable. Fundus examination of both eyes revealed yellowish lesions of 10 mm from superotemporal macula to superotemporal periphery. There was no associated subretinal fluid, heme or significant retinal pigment epithelium changes. B-scan ultrasonography revealed moderate solid elevations as well as high internal reflectivity compatible with calcified lesions. Clinical screening was negative, including calcium metabolism and renal function. These findings excluded the first hypothesis of metastasis, confirming the diagnostic of sclerochoroidal calcifications.

Discussion

Sclerochoroidal calcifications (SCC) present as deposits of calcium pyrophosphate in the sclera and/or choroid, typically in elderly, white individuals. Clinically they are irregular, yellow chorioretinal lesions, usually superotemporal close to the vascular arcade. These deposits are idiopathic in most cases although they can be associated with abnormal calcium–phosphorus metabolism. Ultrasonography confirm the presence of intrinsic calcification. Differential diagnosis include choroidal osteoma, choroidal metastasis, subepithelial infiltrates of large cell ocular lymphoma, amelanotic nevus/melanoma and chorioretinitis. Typically, they remain stable and do not increase in size over time. Cases are considered idiopathic after excluding other pathologies by investigating ocular history and blood tests. Most SCC are far from the fovea and do not cause any visual impairments. Even in rare cases of parafoveal involvement, no treatment protocols have been established. Visual prognosis is usually good. Although SCC is a rare disease it’s important to recognize it in order to avoid unnecessary intervention.

Keywords

Retina, sclerochoroidal calcifications, metastasis, ultrasonography, B-scan

Area

CLINICAL CASE

Authors

Bruno Baldissera Tochetto, Paulo Lucena, Isabela Vianello Valle, Tiago Almeida Cargalho, Vinicius Clementino Falcão, Tiago Carvalho e Silva Figueiredo, Andrea Cristina Nehemy, Marcio Augusto Nogueira Costa