Progression from Bilateral Unifocal to Multifocal Choroidal Metastases: A Multimodal Imaging Case Report of Undiagnosed Lung Cancer.

Purpose: To report the first documented case of progression from bilateral unifocal to multifocal choroidal metastases in a patient with previously undiagnosed lung cancer. Methods: A single case report illustrated with multimodal imaging. Results: A 53-year-old Caucasian male presented with a drop of vision to 20/80 associated with a hyperopic shift from -3.0 to +3.5 diopters in the right eye. Fundus examination revealed subretinal hemorrhages and retinal stress lines caused by a large, creamy subfoveal mass in the right eye, in addition to a smaller, yellow, and asymptomatic lesion located temporal to the fovea in the left eye. A red-free image demonstrated retinal stress lines. Autofluorescence illustrated central hypoautofluorescence surrounded by hyperautofluorescence, while angiography exhibited central hypofluorescence with surrounding progressive hyperfluorescence. Optical coherence tomography exhibited dome-shaped lesions with thickening of the retinal pigment epithelium and choroid, accompanied by subretinal hyperreflective infiltration. Ultrasound examination depicted two choroidal lesions with medium-to-low reflectivity. A subsequent systemic evaluation by an oncologist confirmed primary lung cancer with metastases. An examination 8 weeks later revealed counting fingers in the right eye and 20/30 in the left eye, accompanied by the appearance of multiple new metastases in both eyes and an extensive serous retinal detachment with increased density of hyperreflective speckles. Conclusions: Early ophthalmologic signs may lead to the diagnosis of systemic cancer. A multimodal imaging approach enhances the interpretation of clinical features by providing a comprehensive view of the pathological changes in choroidal metastases.