Circumscribed choroidal hemangioma mimicking choroidal melanoma on magnetic resonance imaging: A rare T2-hypointense presentation

Abstract

To report a rare case of circumscribed choroidal hemangioma (CCH) demonstrating atypical T2 hypointensity on magnetic resonance imaging (MRI), mimicking choroidal melanoma. A 65-year-old male presented with blurred and distorted vision in the left eye. Fundus examination revealed an elevated orange-red choroidal lesion inferior to the optic disc. Optical coherence tomography showed a dome-shaped choroidal mass with subretinal fluid and serous retinal detachment involving the fovea. Ultrasonography demonstrated a hyperechoic lesion with high internal reflectivity. Fluorescein angiography revealed early patchy hyperfluorescence with late staining, while indocyanine green angiography showed early hyperfluorescence with a late wash-out phenomenon. Systemic evaluation was unremarkable. Orbital MRI demonstrated hyperintensity on T1-weighted images and marked hypointensity on T2-weighted sequences, raising suspicion for choroidal melanoma. However, multimodal imaging findings supported the diagnosis of CCH. The diagnosis was confirmed at an ocular oncology center, and photodynamic therapy was performed. At 1-year follow-up, subretinal fluid resolved completely and visual acuity improved. CCH may rarely present with T2 hypointensity on MRI and closely mimic choroidal melanoma. Awareness of this atypical presentation and careful integration of multimodal imaging findings are essential to avoid misdiagnosis and ensure appropriate management.