A Chance Finding of Pigmented Retinal Spots

Kathryn A. Camero, MD; Kimberly G. Yen, MD


September 25, 2015

Case Diagnosis

Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is often discovered as part of a workup to rule out malignant choroidal melanoma. The lesions of malignant melanoma would be elevated with deviated retinal vessels and a lack of distinct margins. In contrast, lesions of CHRPE are flat with well-demarcated borders.

The sunburst lesions of sickle cell disease have feathery borders. Patients with sickle cell disease often demonstrate gliosis on brain imaging and have typical hematologic findings.

When a hemorrhage is found beneath the RPE, the patient often has a history of ocular trauma or macular degeneration. The lesion may appear green with irregular borders. Pigmentation improves over time compared with the stable lesions of CHRPE.

An old chorioretinitis lesion from a toxoplasmosis infection would present with pigmented hyperplasia on the retina periphery with satellite lesions and bare sclera.

Case Diagnosis and Clinical Course

The patient's presentation and ocular examination findings are consistent with a diagnosis of CHRPE.

Photos were taken of the lesions. Images from the dilated fundus examination were sent to a retinal specialist for further evaluation.

The child's mother was instructed to follow up with the specialist.


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