Idiopathic polypoidal choroidal vasculopathy masquerading as choroidal tumors: one year follow-up of a peripheral lesion Vasculopatia polipoidal idiopática da coroide simulando tumores da coroide: um ano de seguimento de uma lesão periférica

Idiopathic polypoidal choroidal vasculopathy (IPCV) is a vascular malformation of the choroid, comprising a network of branching vessels of varying sizes that produce aneurysmal-like enlargements. This disease is generally observed in the peripapillary area, and less commonly as an isolated macular lesion. Frequently, the IPCV vascular network is associated with multiple episodic serosanguineous detachments of the retinal pigment epithelium and neurosensory retina, which occasionally lead to sub-retinal and on rare occasions vitreous hemorrhage. When the vascular network is beneath the atrophied pigment epithelium, a clinical diagnosis of IPCV is recommended if reddish orange, spheroidal, or polyp-like structures are observed. Nevertheless, in the majority of cases these lesions are not clearly visible, and indocyanine green angiography (ICG) is required for diagnosis. ICG images illustrate two components of vascular abnormalities in the choroidal circulation: 1) a branching vascular network and 2) aneurysmal dilations at the end of the vascular network branch. These dilations can also be divided into two patterns: 1) large solitary round aneurysmal dilations, which usually present a stable and favorable clinical course and 2) a collection of small aneurysmal dilations resembling a cluster of grapes, which tend to bleed or leak and cause severe visual loss. Optical coherence tomography (OCT) is another exam used to characterize the IPCV lesion, and is used mainly when retinal pigment epithelium and serous retinal detachment are suspected. However, this approach has not yet been described in peripheral IPCV. A major problem with the diagnosis of peripheral IPCV is that it masquerades as several mass lesions or tumors, such as acquired vasoproliferative disease, metastatic lesions to the choroid, choroidal melanoma, or choroidal osteoma. The goal of this case report was to elucidate the diagnosis of a temporal lesion that mimicked a tumor mass, as well as describe the follow-up approach for assessing treatment need if the patient’s vision becomes threatened or compromised. Idiopathic polypoidal choroidal vasculopathy masquerading as choroidal tumors: one year follow-up of a peripheral lesion