Non-invasive imaging of a choroidal macrovessel

Purpose: To describe novel anatomic findings of an apparent choroidal macrovessel, originally misdiagnosed as a choroidal tumor, using non-invasive imaging tools. Observations: Initial ophthalmic examination revealed an elevated hypopigmented choroidal mass in the macular area, with a serpentine track extending temporally to the equator. Enhanced depth imaging optical coherence tomography (EDI-OCT) revealed an optically hollow lesion just outside the choroid-scleral junction (CSJ), indenting the retina and compressing the choroid from the scleral side. Optical coherence tomography angiography (OCTA) at the choroidal level showed relative low flow within the lesion. En face OCT at the level of the choroid demonstrated similar reflectivity to the physiological adjacent choroidal vessels. Conclusion and importance: Non-invasive imaging can be used to demonstrate the presence and anatomy of a choroidal macrovessel. OCTA is presented as a useful diagnostic imaging test that can distinguish this lesion from alternative diagnoses without the use of dye injection. In addition to the previously published reports of such vessels in the choroid, we suggest a possible anatomic variant infra-choroidal location of a macrovessel and hypothesize its origin.