Quiz: Flashes of Light

A 65-year-old white male who notices occasional “flashes of light” is referred for a pigmented lesion of his left eye. He has an extensive cardiac history and smokes 30 packs of cigarettes a year. Visual acuity, intraocular pressure, pupils, and anterior segment exam are all normal for both eyes. Dilated fundus exam of the right eye is likewise normal; the left eye lesion is shown in these photos. A- and B-scan ultrasound of the lesion revealed a solid lesion measuring 20x17x8 mm with low internal reflectivity and no signs of extra-scleral extension.

Case contributed by: Daniel Neely, MD; Janine Collinge, MD; Maria Lim, MD

7 thoughts on “Quiz: Flashes of Light”

  1. I’d argue a cxr is a waste of radio at this point. You are going to ct and or mri and pet everything anyway so why exposing to additional radio for a far interior test?

  2. Only the dilated fundus exam of the eye are seriously flawed in the diagnosis of choroidal malignant melanoma, and the characteristics of ocular ultrasound, especially B-ultrasound, and CDFI must be considered. Because the treatment of the disease may include enucleation, the preoperative diagnosis must be adequate and confirmed by multiple sources, such as MRI, to determine whether misdiagnosis will occur. This set of questions can mislead the primary clinician.


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