Progression from Bilateral Unifocal to Multifocal Choroidal Metastases: A Multimodal Imaging Case Report of Undiagnosed Lung Cancer.

PURPOSE: To report the first documented case of progression from bilateral unifocal to multifocal choroidal metastases in a patient with previously undiagnosed lung cancer.

METHODS

A single case report illustrated with multimodal imaging.

RESULTS

A 53-year-old Caucasian male presented with a drop of vision to 20/80 associated with a hyperopic shift from -3.0 to +3.5 diopters in the right eye. Fundus examination revealed subretinal hemorrhages and retinal stress lines caused by a large, creamy subfoveal mass in the right eye, in addition to a smaller, yellow, and asymptomatic lesion located temporal to the fovea in the left eye. A red-free image demonstrated retinal stress lines. Autofluorescence illustrated central hypoautofluorescence surrounded by hyperautofluorescence, while angiography exhibited central hypofluorescence with surrounding progressive hyperfluorescence. Optical coherence tomography exhibited dome-shaped lesions with thickening of the retinal pigment epithelium and choroid, accompanied by subretinal hyperreflective infiltration. Ultrasound examination depicted two choroidal lesions with medium-to-low reflectivity. A subsequent systemic evaluation by an oncologist confirmed primary lung cancer with metastases. An examination 8 weeks later revealed counting fingers in the right eye and 20/30 in the left eye, accompanied by the appearance of multiple new metastases in both eyes and an extensive serous retinal detachment with increased density of hyperreflective speckles.

CONCLUSIONS

Early ophthalmologic signs may lead to the diagnosis of systemic cancer. A multimodal imaging approach enhances the interpretation of clinical features by providing a comprehensive view of the pathological changes in choroidal metastases.