Article Text

Choroidal macrovessels: multimodal imaging findings and review of the literature
  1. Beatrice Gallo1,2,
  2. Samantha R de Silva2,
  3. Omar A Mahroo2,3,4,
  4. Zubin Saihan2,
  5. Praveen J Patel2,3,4,
  6. Jonathan G Dowler2,
  7. Carlos Pavesio2,4,
  8. Pearse A Keane2,3,4,
  9. Adnan Tufail2,3,4,
  10. Mandeep S Sagoo1,2,3,4
  1. 1Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  2. 2Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  3. 3Institute of Ophthalmology, University College London, London, UK
  4. 4NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
  1. Correspondence to Dr Beatrice Gallo, Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK;{at}


Background/aims To describe clinical and multimodal imaging features in a cohort of choroidal macrovessels.

Methods Demographics and multimodal imaging features of 16 eyes of 13 patients with choroidal macrovessels were reviewed. The multimodal imaging included colour fundus photography, fundus autofluorescence (FAF), spectral domain enhanced depth imaging optical coherence tomography (OCT), en face OCT, OCT-angiography (OCT-A), B-scan ultrasonography (US), fluorescein angiography (FFA) and indocyanine green angiography (ICGA).

Results Three patients had bilateral involvement. On colour fundus photography, three patterns were evident (a clearly visible orange-red vessel; a track of pigmentary changes; spots of mild pigmentary changes). Vessel orientation was horizontal (11 eyes), oblique (4 eyes) or vertical (1 eye). In 2 eyes, the vessel was extra-macular. OCT in all cases showed a hyporeflective choroidal area with posterior shadowing and elevation of the overlying retina. Subretinal fluid was present in 4 eyes. FAF (12 eyes) was normal (7 eyes) or showed a hypofluorescent/hyperfluorescent track (4 eyes) or linear hyperautofluorescence (1 eye). En-face OCT (2 eyes) revealed the course of the macrovessel at the level of choroid and choriocapillaris. On OCT-A (2 eyes) the vessel had a reflectivity similar to surrounding vessels but larger diameter. B-scan US (8 eyes) showed a nodular hypoechogenic lesion. FFA (5 eyes) showed early focal hyperfluorescence (4 eyes) not increasing in later phases, or was normal (1 eye). ICGA (6 eyes) showed early hyperfluorescence of the vessel.

Conclusions Choroidal macrovessels can mimic other entities, leading to underdiagnosis. Appreciating relevant features on different imaging modalities will aid a correct diagnosis.

  • choroid
  • diagnostic tests/investigation
  • retina

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  • Contributors Study concept and design: BG and MSS. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript and critical revision for important intellectual content: all authors. Final approval of the version to be published: all authors.

  • Funding OAM is funded by the Wellcome Trust (206619_Z_17_Z).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was carried out in compliance with the Declaration of Helsinki and institutional approval was obtained from Moorfields Eye Hospital Research and Development Department (17/031).

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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