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58-year-old man was seen in the office on 9/21/2012. He saw you a few months ago. His eyes were fine and then during a checkup today you noticed choroidal masses in both eyes. He does smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. He does see a cancer specialist at Moffitt but he has been under surveillance for possible melanoma because of his family history. He has not had melanoma. VISUAL ACUITY: His vision is 20/25 in both eyes. IOP: OD 15, OS 20. SLIT LAMP EXAM: There is 1+ nuclear sclerosis in both eyes. The left eye has 1+ cell and flare in the anterior chamber. He is dilated in that eye. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. There is a choroidal lesion, which is elevated, dome-shaped, and hypopigmented superotemporal to the macula. It measures about 11 x 11 mm at the base. OS: Vertical C/D ratio is 0.2. There is a choroidal mass just nasal to the optic nerve which is larger than the one in the other eye. It measures about 15 x 13 mm across. There is also a serous inferior retinal detachment. ULTRASOUND: The ultrasound confirms the relatively low internal reflectivity of both of the masses and the retinal detachment. The height of the lesion in the right eye is 3.8 mm and the height of the lesion in the left eye is 5 mm. COLOR PHOTOGRAPHY: The color photos show the masses to be mostly hypopigmented over the surface with stippling of the retinal pigment epithelium. FLUORESCEIN ANGIOGRAPHY: The FA shows no significant internal circulation to either lesion with just increasing hyperfluorescence from pigment epithelial irregularities over the surface. IMPRESSION: 1. PROBABLE BILATERAL CHOROIDAL METASTASES 2. SEROUS RETINAL DETACHMENT – LEFT EYE DISCUSSION: I explained to the patient, given the time course of the appearance and the ultrasound and fluorescein characteristics of these lesions, they are likely choroidal metastases. As a smoker with chest pain on his right flank, I think the most likely primary would be lung cancer; however, this has not yet been determined. I spoke with someone at Dr Glass’s office today, who is his cutaneous oncologist, and they are going to have a medical oncologist from Moffitt Cancer Center contact him at home later today with an appointment for an urgent evaluation. FU: Biopsy of tumor showed adenocarcinoma, probably primary lung. Patient had tumor in virtually every organ including brain and was placed on medication for cerebral edema.

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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment996 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment504 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment485 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment496 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment526 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment413 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment293 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment315 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment284 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment255 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment257 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment219 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment242 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment218 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment237 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment213 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment282 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment227 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment221 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment245 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment253 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment337 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment358 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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Choroidal Metastases - Both Eyes - Exudative Retinal Detachment361 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes00000
(0 votes)
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58-year-old man was seen in the office on 9/21/2012. He saw you a few months ago. His eyes were fine and then during a checkup today you noticed choroidal masses in both eyes. He does smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. He does see a cancer specialist at Moffitt but he has been under surveillance for possible melanoma because of his family history. He has not had melanoma. VISUAL ACUITY: His vision is 20/25 in both eyes. IOP: OD 15, OS 20. SLIT LAMP EXAM: There is 1+ nuclear sclerosis in both eyes. The left eye has 1+ cell and flare in the anterior chamber. He is dilated in that eye. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. There is a choroidal lesion, which is elevated, dome-shaped, and hypopigmented superotemporal to the macula. It measures about 11 x 11 mm at the base. OS: Vertical C/D ratio is 0.2. There is a choroidal mass just nasal to the optic nerve which is larger than the one in the other eye. It measures about 15 x 13 mm across. There is also a serous inferior retinal detachment. ULTRASOUND: The ultrasound confirms the relatively low internal reflectivity of both of the masses and the retinal detachment. The height of the lesion in the right eye is 3.8 mm and the height of the lesion in the left eye is 5 mm. COLOR PHOTOGRAPHY: The color photos show the masses to be mostly hypopigmented over the surface with stippling of the retinal pigment epithelium. FLUORESCEIN ANGIOGRAPHY: The FA shows no significant internal circulation to either lesion with just increasing hyperfluorescence from pigment epithelial irregularities over the surface. IMPRESSION: 1. PROBABLE BILATERAL CHOROIDAL METASTASES 2. SEROUS RETINAL DETACHMENT – LEFT EYE DISCUSSION: I explained to the patient, given the time course of the appearance and the ultrasound and fluorescein characteristics of these lesions, they are likely choroidal metastases. As a smoker with chest pain on his right flank, I think the most likely primary would be lung cancer; however, this has not yet been determined. I spoke with someone at Dr Glass’s office today, who is his cutaneous oncologist, and they are going to have a medical oncologist from Moffitt Cancer Center contact him at home later today with an appointment for an urgent evaluation. FU: Biopsy of tumor showed adenocarcinoma, probably primary lung. Patient had tumor in virtually every organ including brain and was placed on medication for cerebral edema.