Sentinel Vessel Sign: A Shadow of the Subway Storm Setting into Strike Sight
Published: February 1, 2024 | DOI: https://doi.org/10.7860/JCDR/2024/67055.19039
Rakesh Kumar Jha, Jaya Kaushik, Sunandan Bhatta
1. Assistant Professor, Department of Ophthalmology, Command Hospital, Lucknow, Uttar Pradesh, India.
2. Professor, Department of Ophthalmology, Command Hospital, Lucknow, Uttar Pradesh, India.
3. Assistant Professor, Department of Ophthalmology, Military Hospital, Agra, Uttar Pradesh, India.
Correspondence
Dr. Rakesh Kumar Jha,
Assistant Professor, Department of Ophthalmology, Command Hospital, Cariappa Road, Lucknow Cantonment, Lucknow-226002, Uttar Pradesh, India.
E-mail: rkjhan2@y7mail.com
A 56-year-old woman presented with a complaint of painless diminished vision in the right eye for nine months. Best-corrected visual acuity was 20/400 Oclulus Dexter (OD) and 20/20 Oculus Sinister (OS). Ophthalmological examination revealed a prominent solitary, tortuous, dilated episcleral sentinel vessel in the superonasal aspect of the right eye (white arrow, (Table/Fig 1)a). An undilated examination revealed a normal pupillary area (Table/Fig 1)b, but a dilated examination revealed a retrolental dome-shaped dark-brown mass in the superonasal quadrant protruding into the vitreous cavity (Table/Fig 1)c. Ultrasonography revealed a 9 mm acoustically-solid mass in maximum dimension with medium internal reflectivity (Table/Fig 1)d. A diagnosis of ciliochoroidal melanoma was made. A Computed Tomography (CT) scan of the head excluded extraocular extension (yellow arrow, (Table/Fig 1)e). Metastatic work-up, along with radiological imaging, excluded distant metastasis. Given the involvement of the ciliary body (which carries a worse prognosis), the involved eye was enucleated after due counseling with the patient. Subsequent histopathological examination, along with immunohistochemistry analysis of the lesion, revealed it to be a grade III-pT1-stage malignant melanoma with no local invasion. After enucleation, subsequent follow-up examinations for one year excluded any recurrence.
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