3D Reconstruction with Spiral Computed Tomography in Choroidal Osteoma

doi:10.4236/ojoph.2013.31002

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Open Journal of Ophthalmology, 2013, 3, 4-6

http://dx.doi.org/10.4236/ojoph.2013.31002 Published Online February 2013 (http://www.scirp.org/journal/ojoph)

3D Reconstruction with Spiral Computed Tomography in

Choroidal Osteoma

Francisco Javier Ascaso1,2, Laura Herrera1, Laura Villén1, Rafael Lasierra3, Juan Ibañez1,

Diana Pérez1, José Angel Cristóbal1

1Department of Ophthalmology, Lozano Blesa University Clinic Hospital, Zaragoza, Spain; 2Aragon Health Sciences Institute,

Zaragoza, Spain; 3Department of Radiology, Lozano Blesa University Clinic Hospital, Zaragoza, Spain.

Email: [email protected]; [email protected]; [email protected]; [email protected]; [email protected];

[email protected]; [email protected]

Received September 24th, 2012; revised October 25th, 2012; accepted November 2nd, 2012

ABSTRACT

Choroidal osteoma (CO) is a rare, ossifying benign tumor originated in the choroid that typically occurs in otherwise

healthy young women (1,2). It is characterized by a yellowish, well demarcated lesion in the juxtapapillary or macular

area. The diagnosis is clinical and can be confirmed with the use of fluorescein or indocyanine angiography, optical

coherence tomography, computed tomography or magnetic resonance imaging. Choroidal neovascularization or

subretinal fluid, the main causes for vision loss, can be treated with laser therapy, photodynamic th erapy or intravitreal

anti-vascular endothelial growth factor therapy. We present a case of choroidal osteoma, showing the role of the high

resolution 3D spiral computed tomography.

Keywords: Choroidal Osteoma; 3D Spiral Computed Tomography; Ultrasonography; Fluorescein Angiography

1. Case History

A 28-year-old woman complained of gradual decrease in

visual acuity in her right eye, which was attributed to a

macular lesion. Best-corrected visual acuity in this eye

was 20/400. Funduscopy revealed a well-demarcated,

slightly elevated, yellow-white to orange lesion located

in the juxtapapillary and macular area of the right eye

compatible with a choroidal osteoma (CO) (Figure 1).

Fluorescein angiography showed diffuse patchy hy-

perfluorescence with late-phase generalized tissue stain-

ing (Figure 2). B-scan ultrasonography and especially

computed tomography (CT) were of particular value to

confirm the diagnosis, by showing clearly demonstrable

calcium densities in th e posterior pole of the affected eye

(Figures 3 and 4). A three-dimensional spiral computed

tomography was also made to establish the diagnosis

(Figure 5).

The patient was unsuccessfully treated with two in-

travitreal ranimizumab injections .

2. Discussion

Choroidal osteoma is a rare, ossifying benign tumor that

originates in the choroid. It is usually unilateral and

develops in the second or third decade of life, mostly in

women [1,2]. Funduscopically, it is characterized by a

well-demarcated, slightly elevated, yellow-white lesion

Figure 1. Fundus photograph showing a well-demarcated,

slightly elevated, yellow white to orange lesion located in the

juxtapapillary and macular area of the right eye compatible

with a choroidal osteoma.

Figure 2. Fundus fluoresc ei n angiogr aphy reve aled a diffuse

patchy hyperfluorescence with late-phase generalized tissue

staining.

3D Reconstruction with Spiral Computed Tomography in Choroidal Osteoma 5

Figure 3. B-scan ultrasonography showing clearly demon-

strable calcific densities in the posterior pole of the affected

eye (black arrow) and an associated exudative retinal de-

tachment.

Figure 4. Axial computed tomography (CT) scan reveals a

characteristic, well defined, homogeneously radio-opaque

plaque of bone density in the posterior wall of the right

eyeball, corresponding to a choroidal osteoma (arrow).

Figure 5. 3D reconstruction of CT scan demonstrating a

clearer perception of the extent and location of the tumor

(arrow).

located in the juxtapap illary or macular area. Fluorescein

angiography usually shows diffuse patchy hyperfluo-

rescence with late-phase generalized tissue staining. Op-

tical coherence tomography demonstrates a highly re-

flective cavernous structure [1,2]. Orbital computed to-

mographic scan reveals a characteristic, well-defined, ho-

mogeneously radio-opaque plaque with the same density

as bone at the level of the choroid. This finding enables

to distinguish the CO from various dystrophic lesions:

atypical or amelanotic malignant choroidal melanoma,

metastatic carcinoma, leukemic or lymphomatous infil-

trates, choroidal hemangioma, choroidal scars of the ma-

cula, and organized subretinal hemorrhage [3,4]. How-

ever, multiple diseases are associated with sclerocho-

roidal calcifications, occurring after inflammatory, infec-

tious, and traumatic injuries to the eye in which there are

significant secondary tissue atrophy, degeneration, and

necrosis. Likewise, ocular calcification has been reported

in hyperparathyroidism, acute and chronic renal failure,

sarcoidosis, vitamin D intoxication, and hypercalcemia

[5,6].

CT is the first-line imaging modality for orbital evalu-

ation [5]. Nevertheless, conventional radiography has the

problem of superimposition, and moreover it is a two-

dimensional representation of a three-dimensional object.

Spiral computed tomography (SCT) may be useful in

assessing the size, shape, and location of a CO when

compared to the routine CT scan, avoiding potential pit-

falls in orbital image interpretation. Compared to CT

scan, three-dimensional (3D) SCT is potentially more

useful for the diagno sis of CO: a high resolu tion 3D view

of the CO morphology in sp atial relation to th e surround-

ding orbital structures is achieved, providing with more

details on its size and extension, as well as giving key

information to differentiate it form other diseases asso ci-

ated with calcifications. It also helps in the follow-up of

patients, by showing highly accurately, whether the CO

has responded well to treatment. Disadvantages are its

cost, elevated levels of radiation exposure and, to a lesser

extent, time requirements and the size of the equipment.

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