Optical Coherence Tomography Angiography of Retinal Cavernous Hemangioma

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Retinal cavernous hemangioma (RCH) is a benign vascular tumor that is typically diagnosed on routine examination. The lesion consists of an aggregation of red, saccular aneurysms within the retina. It is often described as a “cluster of grapes” as seen in our patient temporal to the macula (Figure 1A). It is classically located along the course of a retinal vein. Commonly, there is overlying, white, fibroglial tissue on the mass.1–5 We present a 39-year-old woman referred for an asymptomatic mass in the right eye. Best-corrected visual acuity was 20/20 in both eyes. She had no relevant past ocular, medical or family history.
Diagnosis can be made from characteristic findings on ophthalmoscopy. Fluorescein angiography (FA) has a pseudo-pathognomonic finding of arterial phase hypofluorescence (Figure 1B) and late “capping” of the dye superiorly within the aneurysms. Optical coherence tomography (OCT) of the lesion shows multiloculated cavernous spaces within the retina (Figure 1C). There is commonly an overlying epiretinal membrane.1–5
This condition can occur sporadically or as an autosomal dominantly inherited oculoneurocutaneous syndrome where the condition is associated with central nervous system and cutaneous lesions. Our patient refused neuro-imaging after extensive discussion.
The clinical findings and essential imaging features of retinal cavernous hemangioma have been previously published and are noted above.1–5 We are unaware of previous publication of optical coherence tomography angiography (OCTA) findings in retinal cavernous hemangioma (Figure 1D). Optical coherence tomography angiography is a novel imaging technique which obtains high-resolution visualization of the retinal vasculature. We see that OCTA image delineates the entire lesion in similar potential as the fluorescein angiogram noninvasively, without the use of fluorescein dye. Optical coherence tomography angiography provides dynamic information of the retinal cavernous hemangioma, which is lacking on fluorescein angiography. From the OCTA image, we clearly realize the anatomical dilatation of the retinal cavernous hemangioma with one vein as the main dilated vessel draining the mass (Figure 1D). Moreover, OCTA allows us to adjust segmentation and evaluate the scan in a three dimension (3D) fashion.
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