1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Steven J Goldstein Affiliation: University of Kentucky

2. MedPix No: 11836 - History Pt Demographics: Age = 68 y.o. Gender = man 68 year old man with sudden visual loss right eye Downloaded by (-1)

3. MedPix No: 11836 - EXAM & LABS Retinal mass with evidence of retinal detachment on fundoscopy

4. Schematic Diagram of Orbit MR The lens is dark on both T1 and T2, the anterior chamber (aqueous humor) and posterior chamber (vitreous body) are both water: dark on T1 and bright on T2. The orbital and subcutaneous fat are both bright on T1. - Downloaded by (-1)

5. Schematic Diagram of Orbit MR The lens is dark on both T1 and T2, the anterior chamber (aqueous humor) and posterior chamber (vitreous body) are both water: dark on T1 and bright on T2. The orbital and subcutaneous fat are both bright on T1. The normal extraocular muscles enhance with gadolinium, while the normal optic nerve does not. - Downloaded by (-1)

6. Schematic of Retinal detachment In a retinal detachment, the sub-retinal fluid (or blood) cannot dissect past the optic nerve head or disc. - Downloaded by (-1)

7. Schematic of Vitreous (Hyaloid) detachment In a vitreous or hyaloid detachment, there may be a complete separation from the retina, and the sub-hyaloid fluid collection may cross the optic nerve head or disc. - Downloaded by (-1)

8. Ocular Melanoma with retinal detachment Mass in vitreous body right eye arising from the retina. This mass enhances following contrast administration (gadolinium). There is a secondary retinal detachment - which probably caused the sudden visual loss. - Downloaded by (-1)

9. Ocular Melanoma with retinal detachment Mass in vitreous body right eye arising from the retina. This mass (asterisk) enhances following contrast administration (gadolinium). There is a secondary retinal detachment - which probably caused the sudden visual loss. Also labeled: - Arrowhead - basilar artery (flow void) - Arrows - cavernous carotid artery (flow void) - p - pituitary gland - S - sphenoid sinus - - Downloaded by (-1)

10. Ocular Melanoma with retinal detachment Mass in vitreous body right eye arising from the retina. This mass enhances following contrast administration (gadolinium). There is a secondary retinal detachment - which probably caused the sudden visual loss. - Downloaded by (-1)

11. Ocular Melanoma with retinal detachment Mass in vitreous body right eye arising from the retina. This mass enhances following contrast administration (gadolinium). There is a secondary retinal detachment - which probably caused the sudden visual loss. - Downloaded by (-1)

12. Ocular Melanoma with retinal detachment Mass in vitreous body right eye arising from the retina. This mass (asterisk) enhances following contrast administration (gadolinium). There is a secondary retinal detachment - which probably caused the sudden visual loss. Also labeled: - Arrowhead - lens of left eye - S - sphenoid sinus - - Downloaded by (-1)

13. Ocular Melanoma with retinal detachment Mass in vitreous body right eye arising from the retina. This mass enhances following contrast administration (gadolinium). There is a secondary retinal detachment - which probably caused the sudden visual loss. - Downloaded by (-1)

14. Ocular Melanoma with retinal detachment Mass in vitreous body right eye arising from the retina. This mass enhances following contrast administration (gadolinium). There is a secondary retinal detachment - which probably caused the sudden visual loss. - - Downloaded by (-1)

15. Ocular Melanoma with retinal detachment Mass in vitreous body right eye arising from the retina. This mass enhances following contrast administration (gadolinium). There is a secondary retinal detachment - which probably caused the sudden visual loss. - - Downloaded by (-1)

16. Ocular Melanoma with retinal detachment Mass in vitreous body right eye arising from the retina. This mass enhances following contrast administration (gadolinium). There is a secondary retinal detachment - which probably caused the sudden visual loss. Also labeled: - 4th ventricle - S - sphenoid sinus - - Downloaded by (-1)

17. Ocular Melanoma with retinal detachment Mass in vitreous body right eye arising from the retina. This mass enhances following contrast administration (gadolinium). There is a secondary retinal detachment - which probably caused the sudden visual loss. - - Downloaded by (-1)

18. Ocular Melanoma with retinal detachment Mass in vitreous body right eye arising from the retina. This mass enhances following contrast administration (gadolinium). There is a secondary retinal detachment - which probably caused the sudden visual loss. - - Downloaded by (-1)

19. Ocular Melanoma with retinal detachment Mass in vitreous body right eye arising from the retina. This mass enhances following contrast administration (gadolinium). There is a secondary retinal detachment - which probably caused the sudden visual loss. - - Downloaded by (-1)

20. Ocular Melanoma with retinal detachment Non-specific white-matter changes. There is a mass in vitreous body right eye arising from the retina. This mass enhances following contrast administration (gadolinium). There is a secondary retinal detachment - which probably caused the sudden visual loss. - - Downloaded by (-1)

21. Ocular Melanoma with retinal detachment Mass in vitreous body right eye arising from the retina. This mass (asterisk) enhances following contrast administration (gadolinium). There is a secondary retinal detachment - which probably caused the sudden visual loss. Also labeled: - a - atrium of right lateral ventricle - m - maxillary sinus - - Downloaded by (-1)

22. FINDINGS Mass right eye. Retinal detachment

23. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? metastatic disease - trauma - spontaneous retinal detachment - Retinoblastoma (in children) - Ocular (retinal) melanoma

24. Diagnosis: Ocular melanoma Dx Confirmed by: Imaging, surgery, pathology

25. DISCUSSION The sudden loss of vision was caused by the retinal detachment, which is related to the enhancing intra-ocular mass - the uveal melanoma. The uveal tract consists of: - iris - ciliary body - choroid (vascular) - Although there is a pigment epithelial layer in the retina, it is not the site of origin for this tumor. - - http://en.wikipedia.org/wiki/Uveal_melanoma - - Types or ocular/retinal detachments: - http://www.aafp.org/afp/2004/0401/p1691.html - http://rad.usuhs.edu/medpix/pod.html?mode=case_viewer&imageid=28670&pt_id=&quiz= no#top