CLINICAL HISTORY
A 43 year male presented to trauma services with loss of consciousness after being trampled by a horse. No focal neurological deficit was observed. Pupils were equal and reactive to light, with intact extra ocular muscle movements. Fundoscopy however showed a subretinal mass in the left eye.
IMAGING FINDINGS
Emergency room head CT without contrast was initially reported as a left globe superior temporal quadrant subretinal hemorrhage with intact scleral margins (figure 1). Intracranial contents were normal. Fundoscopic examination by an ophthalmologist showed a sub retinal mass prompting further investigation.
Orbital MRI with and without contrast shows a para-midline left globe superior temporal quadrant choroid layer lesion slightly T1 hyperintense prior to contrast injection and with homogeneous enhancement after. This favored the diagnosis of choroidal melanoma rather than hemorrhage (figures 2 and 3).
PET CT showed no hypermetabolic lesion or systemic disease (Figure 4).
Biopsy for histopathology however confirmed the presence of melanoma, which was treated with an intraocular radioactive brachytherapy plate.