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Hemangioma da coroideia : caso clínico
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O hemangioma da coroideia é um tumor vascular benigno da úvea que poderá apresentar -se como circunscrito (HCC) ou difuso (HDC). O HCC é espontâneo e manifesta-se na idade adulta, enquanto que o HDC é congénito e apresenta-se na forma de uma facomatose neuro-oculo-cutânea – síndrome de Sturge-Weber (SSW).
JN, sexo masculino, 91 anos, apresenta-se no serviço de oftalmologia do HSM por perda progressiva de visão no olho direito (OD). Após observação clínica, é realizada uma ecografia do globo ocular (EGO) que sugere o diagnóstico de HCC. A angiografia com fluoresceína (AF) e a angiografia com indocianina verde (ICV) confirmam o diagnóstico.
É submetido a fototerapia dinâmica (PDT) em março e outubro de 2011.
O HCC manifesta-se no adulto através da baixa da acuidade visual (AV). O HDC manifesta-se frequentemente na adolescência. A AF e ICV são eficazes no diagnóstico de ambos os hemangiomas. De todas as opções terapêuticas, a PDT é a mais vantajosa. No caso clínico, averigua-se a diminuição da visão do OD, partindo da clínica. Os angiogramas confirmam o diagnóstico de HCC. Como a PDT não apresentou alterações significativas sintomática e imagiologicamente e como se tratava de um doente idoso, optou-se por follow-up.
Choroidal hemangioma is a benign vascular tumor of the choroid and can be either circumscribed (CCH) or diffuse (DCH). CCH is spontaneous and usually diagnosed in adulthood, whereas HDC is congenital and occurs as part of a neuro-oculo-cutaneous hemagiomatosis - Sturge-Weber syndrome (SSW). J.N., male, 91, is observed at the HSM’s Ophtalmology department because of progressive loss of visual acuity (VA) on the right eye (RE). After clinical observation, an eye ultrasound (EU) is performed, suggesting CCH. To confirm the diagnosis, a fluorescein angiogram (FA) and an angiogram with indocianine green (ICG) are performed. Photodynamic therapy (PDT) was required in February and October 2011. HCC is diagnosed in adulthood, provoking loss of VA. The HDC is causes symptoms in adolescence. The AF and ICV are effective in the specific diagnosis of both hemangiomas. Of all available therapies, the PDT offers the most advantages. In this case-report, the patient’s loss of VA is investigated, initially by clinical examination. Imaging studies confirm the diagnosis of HCC. As the PDT did not present significant changes in terms of symptoms and imaging studies and the patient was elderly, only follow-up has been since then required.
Choroidal hemangioma is a benign vascular tumor of the choroid and can be either circumscribed (CCH) or diffuse (DCH). CCH is spontaneous and usually diagnosed in adulthood, whereas HDC is congenital and occurs as part of a neuro-oculo-cutaneous hemagiomatosis - Sturge-Weber syndrome (SSW). J.N., male, 91, is observed at the HSM’s Ophtalmology department because of progressive loss of visual acuity (VA) on the right eye (RE). After clinical observation, an eye ultrasound (EU) is performed, suggesting CCH. To confirm the diagnosis, a fluorescein angiogram (FA) and an angiogram with indocianine green (ICG) are performed. Photodynamic therapy (PDT) was required in February and October 2011. HCC is diagnosed in adulthood, provoking loss of VA. The HDC is causes symptoms in adolescence. The AF and ICV are effective in the specific diagnosis of both hemangiomas. Of all available therapies, the PDT offers the most advantages. In this case-report, the patient’s loss of VA is investigated, initially by clinical examination. Imaging studies confirm the diagnosis of HCC. As the PDT did not present significant changes in terms of symptoms and imaging studies and the patient was elderly, only follow-up has been since then required.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Hemangioma da coroideia Úvea Terapia fotodinâmica (PDT) Oftalmologia