Table 3 Characteristics of the differential diagnosis to a choroidal sarcoid granuloma

Metastasis

Yellow subretinal mass posterior to the equator with subretinal fluid

Alternative: Orange mass or brown, grey lesions

Echo-dense lesions (B-scan) with high internal reflectivity (A-scan)

Early hypofluorescence in the arterial phase and late hyperfluorescence in the venous phase

Areas of hyperautofluorescence corresponding to subretinal fluid and lipofuscin (scattered clumps of brown pigment)

Undulating surface overlying the metastasis and thickening of the retinal pigment along areas of subretinal fluid

Hypocyanescence at all stages

Amelanotic Melanoma

Flat, or slightly elevated yellow white lesions, with poorly defined margins and often associated with drusen, prominent vascularity, subretinal fluid, a serous retinal detachment, and lipofuscin with an orange or golden-brown appearance

Acoustically hollow lesions (B-scan) with low internal reflectivity (A-scan)

Double circulation, extensive leakage with progressive fluorescence, late staining of the lesions, and multiple areas of pinpoint leaks affecting the retinal pigment epithelium

Hyperautofluorescence corresponding to areas of orange pigment

Retinal disruptions, detachments, debris, and hyperreflective foci

Deep areas of microcirculation and smooth, well-demarked areas of hypocyanescence in the late phase

Lymphoma

Multifocal creamy-yellow patches at the level of the choroid often with subretinal fluid, a diffuse distribution, ill-defined margins, and a lack of intrinsic pigmentation

Acoustically hollow thickening of the choroid with areas of posterior epibulbar extensions (B-scan)

Granular (leopard spot pattern) appearance and hypofluorescence in the early to mid-phases

Areas of hyperautofluorescence

Segments of the retinal pigment epithelium that are nodular, elevated, hyperreflective, or detached

Clusters of small hypocyanescent lesions