Bilateral Choroidal Osteomas in an Elderly Woman: A Case Report

Abstract

Choroidal osteoma is a rare clinical entity of unknown etiology. It is a benign ossifying tumor characterized by mature bone replacing choroid. It typically affects young females, unilaterally. Vision loss occurs mainly due to photoreceptor degeneration secondary to decalcification and/or development of choroidal neovascularization, especially if located near the macular area. We present a case of an old woman with bilateral choroidal osteomas identified incidentally. An 84-year-old Caucasian woman who was asymptomatic, without clinical features suggestive of choroidal osteoma, was referred to our hospital for a follow-up visit. On the fundus examination, both eyes showed a suspected lesion. B-scan ultrasound demonstrated bilateral highly reflective calcified lesions within the choroid, with an evident cone of shadow, suggestive of choroidal osteoma. Further investigations have performed to confirm the diagnosis. Although the literature reports a more common one-sidedness and typical manifestation of choroidal osteoma in the teenage years, our case report refers to bilateral choroidal osteomas in an elderly woman.

Keywords: CT scan; Choroid; Mottled depigmentation; Osteoma; Ultrasound.

Fig. 1

Fundus photos showed bilateral yellowish-white lesions with well-demarcated borders located supero-temporally; right eye on the right and left eye on the left.

Fig. 2

The fundus autofluorescence revealed two bilateral hypo-autofluorescent areas, located outside to the supero-temporal posterior pole edge; right eye on the right and left eye on the left.

Fig. 3

OCT showed a retinal lift with a slight thinning of the retina and a choroidal thickening with some choroidal large vessels. No CNV was detected; right eye up and left eye down.

Fig. 4

Irregular hyper-echogenic calcified lesion in the posterior choroid demonstrated by B-scan ultrasound; right eye on the right and left eye on the left.

Fig. 5

Two different CT scans showed an asymmetrical and irregular calcified lesion in the posterior choroid in both supero-temporal choroids; on the right a transversal scan of the orbits, on the left sagittal scan of the orbits.