9例眼内出血性疾病误诊为脉络膜黑色素瘤的因为分析

摘要

Objective To analyse the reasons of misdiagnosing retinal or choroidal hemorrhage as choroidal melanoma.Methods Retrospective analysis was performed on clinical data of 9 cases suffering from retinal or choroidal hemorrhage misdiagnosed as choroidal melanoma,which were finally confirmed by histopathology, in ophthalmology of West China Hospital in nearly 27 years.Results For the 9 patients with mean age of 31 ～82years old, courses of disease vary from five days to six months, of which 4 were within 2 weeks and only one case had history of hypertension.The main clinical manifestations for the 9 cases were decreased visual acuity or visual field occlusion.The visual acuity for eight cases was declined from the light perception to count fingers.For only one case, the visual acuity was corrected to 0.4.The number of cases for lens and vitreous opacities was respectively three.The eyeground of 6 patients could not be peeped into through ophthalmoscope.3 patients were revealed with tumor by ophthalmoscopic examination.One patient was accompanied with retinal detachment.Supplementary examination:Seven cases were examined by type-B ultrasonic indicating solid lumps within the eyeball.MRI examination indicated 6 cases probably suffered from choroidal melanoma.Three cases were examined by CT indicating some certain lumps were in the eyeball.Three cases with refractive transparence were not examined by FFA.All patients were not examined by color Doppler ultrasound.Treatment:8 patients underwent enucleation, and 1 patient vitrectomy.Pathological diagnosis:Eight cases suffered from retinal hemorrhage, and 1 case choroidal hemorrhage of ciliary body.Conclusion Incomplete understanding of medical history, refractive turbidity and lack of necessary supplementary examination constitute the main reasons for misdiagnosis.%目的 探讨视网膜、脉络膜下出血误诊为脉络膜黑色素瘤的因为.方法 回顾性分析华西医院眼科近27年来经组织病理学证实的9例视网膜或脉络膜下出血误诊为脉络膜黑色素瘤患者的临床资料.结果 9例患者就诊年龄31～82岁;病程5d~半年,4例在2周以内;仅1例有高血压病史.主要临床表现为视力下降或视野遮挡;8例视力光感至数指,仅1例矫正视力达0.4;晶体混浊和玻璃体混浊各3例,眼底不能窥入6例,眼底镜检查可见肿物3例,1例伴视网膜脱离.辅助检查:7例B超提示球内实性肿块;6例MRI检查提示多系脉络膜黑色素瘤;3例CT检查提示球内占住;3例屈光间质透明者均未行FFA检查;所有患者均未行彩超检查.治疗:8例患者行眼球摘除术,1例患者行玻璃体切割术.病理论断:8例视网膜下出血,1例睫状体脉络膜下出血.结论 对病史了解不全面、屈光间质混浊、缺乏必要的辅助检查是误诊的主要因为.