Choroidal macrovessel is the term currently used for a rare choroidal vascular abnormality that may present as a small choroidal mass with or without symptoms. It usually appears as a dilated, tortuous choroidal vessel beneath the temporal macula and may extend to the periphery. A dilation of the posterior ampulla may elevate the overlying retina (see OCT image below) and cause secondary changes in the retinal pigment epithelium, rarely with subretinal fluid. Choroidal macrovessel is usually diagnosed during adulthood with a female predilection. There is no known associated systemic vascular abnormality.
Another term that may be somewhat more specific for this condition is posterior aneurysmal choroidal varix. An aneurysmal varix is a markedly dilated and tortuous vessel, sometimes used to describe a dilated vascular channel due to a direct communication of an artery and a vein. In the example below, there appeared to be a direct communication between a short posterior choroidal artery and a choroidal vein (Haller vein) as seen on ICG angiography where there was early filling of the lesion in the arterial phase. On the color photo, the prominence of the lesion diminishes in appearance as the vessels track toward the vortex outflow. This is likely due to numerous collateral venous channels that are known to exist, which allows for a reduction in blood flow and intraluminal pressure. Thus, the peripheral choroidal venous channels appear unremarkable.
The most helpful diagnostic tests include optical coherence tomography (OCT) and indocyanine green angiography (ICGA). OCT shows a small hyporeflective choroidal mass temporal to the fovea. There may be disruption of the outer retinal bands and/or subretinal fluid. ICGA shows early filling of the prominently dilated and tortuous choroidal vessel.
As choroidal macrovessels are usually asymptomatic, no treatment is needed. Their importance is primarily to differentiate them from tumors. Rarely, they cause disruption of retinal pigment epithelium resulting in simulated “tracks”, which may be confused for ophthalmomyiasis (subretinal larva).
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.
Copyright © 2023 Designs Unlimited of Florida. All Rights Reserved.