IOTM: Exophytic Papillary Angioma

Image of the Month (IOTM) is a collection of interesting clinical cases with high quality images for all relevant imaging modalities (ex: color fundus, OCT, OCTA, FAF, FA, En Face, Red-free, choroidal vasculography (CVG), anterior imaging) and other clinical results if relevant (ex: visual field plots). Each case is submitted by an eye care professional using one of Topcon’s industry-leading OCT devices.

Case background

A 50-year-old female patient with known history of von Hippel-Lindau disease. Her left eye is blind and the right eye was treated with focal laser coagulation in 1999 for a small retinal angioma in the temporal periphery. Since then no treatment of the right eye was necessary. For some weeks, she has blurred vision and on SD-OCT the general ophthalmologist found some intraretinal fluid next to the optic disc.

The vision was still 20/20.

Diagnosis: Exophytic Papillary Angioma

We performed a 9 x 9mm Swept Source OCT-A(1) using the central fixation to get both macula and optic disc in one scan visualized. The SS-OCT-A of the superficial capillaries (A) was normal but in the deeper layer (B), a vascular structure was detected at the temporal margin of the optic disc. On B-Scan a solid intraretinal mass with confined vascular flow (C, arrow) was shown. There was no contact to RPE and the SS-OCT-A of the sub-RPE layers was normal, so that a juxtapapillary CNV could be excluded. The diagnosis of an exophytic papillary angioma was made. The dimension of the angioma (BxLxH 640 x 1028 x 276μm) was measured by vertical and horizontal B-Scans (D, E). The en-face mode (F) demonstrated much more detailed information about the two-dimensional extend of the angioma and the surrounding exudation compared to the fundus photo (G).

Because of the symptomatic clinical presentation, a systemic treatment with propranolol hydrochloride (3mg/kg) was initiated.

— Ass. Prof. Gerasimos Anastassiou, MD, PhD

Slide A
Slide B
Slide C
Slide D
Slide E
Slide F
Slide G
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The opinions, ideas, views and assumptions expressed are the author’s own and do not necessarily represent the views of Topcon, nor do they constitute advice from Topcon.

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