Open Journal of Ophthalmology, 2013, 3, 4-6 Published Online February 2013 (
3D Reconstruction with Spiral Computed Tomography in
Choroidal Osteoma
Francisco Javier Ascaso1,2, Laura Herrera1, Laura Villén1, Rafael Lasierra3, Juan Ibañez1,
Diana Pérez1, José Angel Cristóbal1
1Department of Ophthalmology, Lozano Blesa University Clinic Hospital, Zaragoza, Spain; 2Aragon Health Sciences Institute,
Zaragoza, Spain; 3Department of Radiology, Lozano Blesa University Clinic Hospital, Zaragoza, Spain.
Received September 24th, 2012; revised October 25th, 2012; accepted November 2nd, 2012
Choroidal osteoma (CO) is a rare, ossifying benign tumor originated in the choroid that typically occurs in otherwise
healthy young women (1,2). It is characterized by a yellowish, well demarcated lesion in the juxtapapillary or macular
area. The diagnosis is clinical and can be confirmed with the use of fluorescein or indocyanine angiography, optical
coherence tomography, computed tomography or magnetic resonance imaging. Choroidal neovascularization or
subretinal fluid, the main causes for vision loss, can be treated with laser therapy, photodynamic th erapy or intravitreal
anti-vascular endothelial growth factor therapy. We present a case of choroidal osteoma, showing the role of the high
resolution 3D spiral computed tomography.
Keywords: Choroidal Osteoma; 3D Spiral Computed Tomography; Ultrasonography; Fluorescein Angiography
1. Case History
A 28-year-old woman complained of gradual decrease in
visual acuity in her right eye, which was attributed to a
macular lesion. Best-corrected visual acuity in this eye
was 20/400. Funduscopy revealed a well-demarcated,
slightly elevated, yellow-white to orange lesion located
in the juxtapapillary and macular area of the right eye
compatible with a choroidal osteoma (CO) (Figure 1).
Fluorescein angiography showed diffuse patchy hy-
perfluorescence with late-phase generalized tissue stain-
ing (Figure 2). B-scan ultrasonography and especially
computed tomography (CT) were of particular value to
confirm the diagnosis, by showing clearly demonstrable
calcium densities in th e posterior pole of the affected eye
(Figures 3 and 4). A three-dimensional spiral computed
tomography was also made to establish the diagnosis
(Figure 5).
The patient was unsuccessfully treated with two in-
travitreal ranimizumab injections .
2. Discussion
Choroidal osteoma is a rare, ossifying benign tumor that
originates in the choroid. It is usually unilateral and
develops in the second or third decade of life, mostly in
women [1,2]. Funduscopically, it is characterized by a
well-demarcated, slightly elevated, yellow-white lesion
Figure 1. Fundus photograph showing a well-demarcated,
slightly elevated, yellow white to orange lesion located in the
juxtapapillary and macular area of the right eye compatible
with a choroidal osteoma.
Figure 2. Fundus fluoresc ei n angiogr aphy reve aled a diffuse
patchy hyperfluorescence with late-phase generalized tissue
Copyright © 2013 SciRes. OJOph
3D Reconstruction with Spiral Computed Tomography in Choroidal Osteoma 5
Figure 3. B-scan ultrasonography showing clearly demon-
strable calcific densities in the posterior pole of the affected
eye (black arrow) and an associated exudative retinal de-
Figure 4. Axial computed tomography (CT) scan reveals a
characteristic, well defined, homogeneously radio-opaque
plaque of bone density in the posterior wall of the right
eyeball, corresponding to a choroidal osteoma (arrow).
Figure 5. 3D reconstruction of CT scan demonstrating a
clearer perception of the extent and location of the tumor
located in the juxtapap illary or macular area. Fluorescein
angiography usually shows diffuse patchy hyperfluo-
rescence with late-phase generalized tissue staining. Op-
tical coherence tomography demonstrates a highly re-
flective cavernous structure [1,2]. Orbital computed to-
mographic scan reveals a characteristic, well-defined, ho-
mogeneously radio-opaque plaque with the same density
as bone at the level of the choroid. This finding enables
to distinguish the CO from various dystrophic lesions:
atypical or amelanotic malignant choroidal melanoma,
metastatic carcinoma, leukemic or lymphomatous infil-
trates, choroidal hemangioma, choroidal scars of the ma-
cula, and organized subretinal hemorrhage [3,4]. How-
ever, multiple diseases are associated with sclerocho-
roidal calcifications, occurring after inflammatory, infec-
tious, and traumatic injuries to the eye in which there are
significant secondary tissue atrophy, degeneration, and
necrosis. Likewise, ocular calcification has been reported
in hyperparathyroidism, acute and chronic renal failure,
sarcoidosis, vitamin D intoxication, and hypercalcemia
CT is the first-line imaging modality for orbital evalu-
ation [5]. Nevertheless, conventional radiography has the
problem of superimposition, and moreover it is a two-
dimensional representation of a three-dimensional object.
Spiral computed tomography (SCT) may be useful in
assessing the size, shape, and location of a CO when
compared to the routine CT scan, avoiding potential pit-
falls in orbital image interpretation. Compared to CT
scan, three-dimensional (3D) SCT is potentially more
useful for the diagno sis of CO: a high resolu tion 3D view
of the CO morphology in sp atial relation to th e surround-
ding orbital structures is achieved, providing with more
details on its size and extension, as well as giving key
information to differentiate it form other diseases asso ci-
ated with calcifications. It also helps in the follow-up of
patients, by showing highly accurately, whether the CO
has responded well to treatment. Disadvantages are its
cost, elevated levels of radiation exposure and, to a lesser
extent, time requirements and the size of the equipment.
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Copyright © 2013 SciRes. OJOph
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