Idiopathic Unilateral Vortex Vein Dilation: A Multimodal Imaging Case Report Abstract

Idiopathic Unilateral Vortex Vein Dilation: A Multimodal Imaging Case Report Abstract | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Idiopathic Unilateral Vortex Vein Dilation: A Multimodal Imaging Case Report Abstract Xiaohui Tian, Leibing Ji, Reyisai Abudulamu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7427936/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Dec, 2025 Read the published version in BMC Ophthalmology → Version 1 posted 12 You are reading this latest preprint version Abstract Purpose: To report a case of idiopathic vortex vein dilatation diagnosed using multimodal imaging, including indocyanine green angiography (ICGA), sodium fluorescein angiography (FFA), wide-angle color fundus photography, fundus autofluorescence (FAF), and ocular ultrasound. Methods: Vortex vein dilatation is a clinically rare phenomenon, often incidentally detected during imaging. Its characteristic fundus appearance can mimic choroidal tumors or vascular lesions, potentially leading to unnecessary intervention. Current literature lacks sufficient reports of idiopathic cases and detailed descriptions of their imaging characteristics. We describe a 51-year-old male patient with an abnormal fundus finding in the left inferotemporal quadrant during routine examination. Multimodal imaging (color fundus photography, ocular ultrasound, FFA, and ICGA) excluded secondary causes, confirming a diagnosis of idiopathic cystic vortex vein dilatation. Conclusion: Idiopathic vortex vein dilatation exhibits distinctive multimodal imaging features. These findings provide diagnostic criteria to assist clinicians in achieving an accurate diagnosis and avoiding misdiagnosis. Vortex Vein Dilation Multimodal Imaging Idiopathic Disease Diagnostic Errors Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction The vortex venous system serves as the primary drainage pathway for the choroid. Typically, 4 to 6 vortex veins collect blood flow from the choroid, iris, and ciliary body [1]. These veins are predominantly located in the superotemporal and inferotemporal quadrants, with the superotemporal quadrant acting as the main drainage route [ 1 ] . Originating from the choroidal capillary network, the veins converge into the ampulla before obliquely traversing the sclera at the equator and draining into the superior and inferior ophthalmic veins. Abnormal dilation of the vortex vein ampulla constitutes vortex vein dilatation (VVD).While VVD typically does not threaten vision or require treatment, its clinical significance lies in distinguishing it from sight-threatening or malignant retinal lesions, such as choroidal melanoma, nevus, metastasis, subretinal hemorrhage, or choroidal hemangioma. Characteristic fundus findings of VVD can be misdiagnosed as choroidal tumors or vascular malformations, potentially leading to unnecessary interventions. Although VVD is frequently reported in association with conditions like Sturge-Weber syndrome, carotid-cavernous fistula (CCF), or elevated intraocular pressure [ 2 , 3 ] , idiopathic VVD remains rare. Previous literature lacks detailed descriptions of the multimodal imaging characteristics specific to idiopathic VVD. This case report provides high-resolution imaging evidence to support the accurate diagnosis of idiopathic VVD and its differentiation from malignant lesions and choroidal vascular pathologies. Case Report A 51-year-old male presented following the incidental discovery of an abnormal fundus finding in the left inferotemporal quadrant during a routine physical examination. The patient reported no visual impairment, metamorphopsia, or ocular pain and had no significant medical history. Best-corrected visual acuity was 20/20 in both eyes. Intraocular pressure measured 14 mmHg (OD) and 15 mmHg (OS). Anterior segment examination was unremarkable. Multimodal Imaging Findings Figure 1 Figure 2 Figure 3 Figure 4 Discussion The vortex venous system is the principal drainage route for choroidal blood flow, accounting for approximately 90% of intraocular venous drainage . Balance in choroidal venous pressure is critical for vascular stability; venous drainage obstruction can lead to secondary intraocular pressure elevation and retinal perfusion abnormalities [4] . Histologically, the wall of the vortex vein comprises three distinct layers. The innermost layer consists primarily of endothelial cells, forming a critical component of the blood-retinal barrier. The middle layer contains smooth muscle cells and elastic fibers, which regulate venous tone and contractility. Pathological proliferation or atrophy of these smooth muscle cells can disrupt venous tone regulation, impairing blood flow dynamics within the vortex vein. The outermost layer is composed of collagen fibers, elastic fibers, and other connective tissue elements, providing essential mechanical support and resistance against dilation. While this structural configuration enables the vein to withstand physiological hemodynamic forces, it may also confer an inherent susceptibility to pathological dilation [5-7] . Retrospective studies indicate that approximately 67% of VVD occurs in the scleral segment, characterized by significant diameter increase and cystic changes [8] . Furthermore, vortex vein dilatation in this region can create high-pressure zones, potentially contributing to conditions like central serous chorioretinopathy (CSC), highlighting its anatomical vulnerability [9] . Pathologically, VVD manifests as focal cystic or fusiform dilation of the vortex vein lumen. The primary clinical challenge is its differentiation from other fundus pathologies, particularly choroidal malignancies, due to its characteristic purplish-red, elevated appearance. The risk of misdiagnosis is substantial. One study found that among six patients initially diagnosed with choroidal lesions (including three with choroiditis), two were ultimately diagnosed with VVD, with one-third having received unnecessary treatment [10] . A European study reviewing 715 patients initially diagnosed with choroidal melanoma found that 40.5% actually had choroidal nevi, 12% had hemorrhagic/exudative retinopathy, 10.5% had choroidal hemangioma, and 4% had age-related macular degeneration (AMD) [11] . Such misdiagnoses carry significant emotional and clinical consequences for patients. The etiology of VVD includes aging, choroidal blood flow disorders, obstruction, and congestion. Aging is a significant factor; degenerative changes in the vein wall and hemodynamic alterations occur with age. Studies measuring central vortex vein diameter (CVVD), mean root area (MRAVV), and maximum branch diameter (WMTBD) show significant increases, particularly in individuals over 61 years [12] . Hemodynamic abnormalities are central to VVD pathogenesis. Conditions like CSC involve venous outflow obstruction leading to vortex vein dilatation [9,13-14] . Similarly, polypoidal choroidal vasculopathy (PCV) exhibits significant dilation of posterior choroidal veins compared to healthy eyes [15] . Secondary VVD also occurs in conditions like CCF, where arteriovenous shunting into the superior ophthalmic vein increases venous pressure, causing compensatory vortex vein dilatation [2,16,17] . Isolated idiopathic VVD, lacking an identifiable systemic or ocular cause, is rarely reported. Such cases often present asymptomatically and pose a higher risk of misdiagnosis. Idiopathic VVD is exceptionally rare. In this case, we utilized wide-angle fundus photography, FAF, high-resolution ICGA, FFA, and ocular ultrasound to comprehensively characterize the lesion. These multimodal imaging findings provide crucial evidence to distinguish idiopathic VVD from mimickers such as choroidal melanoma, CSC, PCV, AMD, and other vascular lesions that may present with similar fundus features or secondary vortex vein changes. Accurate diagnosis via multimodal imaging is essential to prevent unnecessary interventions and ensure appropriate patient management. Declarations Ethics approval and consent to participate: All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal. Availability of data and materials: Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. Funding: No specific grant was received from any funding agency in the public, commercial, or not-for-profit sectors for the preparation of this case report. Competing interest: The authors declare no competing interests. Acknowledgements The authors would like to thank the patient for granting permission to publish this case report and for providing informed consent. Author Contributions Statement Xiaohui Tian and Leibing Ji were responsible for the collection of image data and drafting the manuscript. ReYiSai Abudulamu participated in writing the manuscript. All authors reviewed and approved the final version of the manuscript. References He G, Zhang X, Ji Y, Li M, Hao X, Zhuang X, Pu J, Mi L, Wen F. Distribution and Morphologic Characteristics of Choroidal Vortex Veins in Pachychoroid Disease. Photodiagnosis Photodyn Ther. 2024;50:104404. https://doi.org/10.1016/j.pdpdt.2024.104404 . Fang J, Wang G, Song Y. Giant Carotid-Cavernous Fistula with Complete Shunt. World Neurosurg. 2025;193:155–7. https://doi.org/10.1016/j.wneu.2024.10.085 . Senthilkumar VA, Prakash S, Puthuran GV, Uduman MS, Krishnadas SR, Gedde SJ. Surgical Outcomes of Early Versus Late Onset Glaucoma Associated With Sturge-Weber Syndrome. J Glaucoma. 2024;33(7):516–22. https://doi.org/10.1097/IJG.0000000000002374 . Matsumoto H, Mukai R, Saito K, Hoshino J, Kishi S, Akiyama H. Vortex Vein Congestion in the Monkey Eye: A Possible Animal Model of Pachychoroid. PLoS ONE. 2022;17(9):e0274137. https://doi.org/10.1371/journal.pone.0274137 . Kibur RT, Aavik A, Torga T, Arend A, Aunapuu M. Morphological Study of Incompetent Saphenous Veins: Apoptosis and Ultrastructural Changes of Smooth Muscle Cells. Int Angiol. 2024;43(2):229–39. https://doi.org/10.23736/S0392-9590.24.05107-1 . Hu Q, Guo Y, Fan H, Wu X, Chen H, Zeng C. Pathological Features of Vascular Wall in Dieulafoy’s Disease. Pathol Res Pract. 2023;249:154782. https://doi.org/10.1016/j.prp.2023.154782 . Wang M, McGraw KR, Monticone RE, Pintus G. Unraveling Elastic Fiber-Derived Signaling in Arterial Aging and Related Arterial Diseases. Biomolecules 2025, 15 (2), 153. https://doi.org/10.3390/biom15020153 Matsumoto H, Hoshino J, Nakamura K, Ohyama Y, Morimoto M, Mukai R, Sumiyoshi H, Nakamura T, Kishi S, Akiyama H. Quadrant Laser Photocoagulation Trial to Ameliorate Choroidal Congestion in Central Serous Chorioretinopathy. Jpn J Ophthalmol. 2023;67(2):156–63. https://doi.org/10.1007/s10384-023-00976-x . Kawamura A, Mori R, Tanaka K, Wakatsuki Y, Fujita K, Nakashizuka H. Choroidal Circulation Time by Wide-Field Indocyanine Green Angiography in Central Serous Chorioretinopathy. Jpn J Ophthalmol. 2025. https://doi.org/10.1007/s10384-025-01188-1 . Xue K, Meng F, Ren H, Yue H, He LJ, Ma R, Lin X, Qian J, Guo J. Acute Spontaneous Vortex Vein Occlusion: Clinical Features, Multimodal Imaging and Natural Course. Br J Ophthalmol. 2024;108(11):1571–7. https://doi.org/10.1136/bjo-2023-324712 . Roca-Cabau MA, Kumaran N, Asencio-Durán M, Pita-Ortiz I, Dabad Moreno JV. Pseudomelanoma Diagnosis in a Tertiary Ophthalmologic Centre in Spain. Can J Ophthalmol. 2024;59(6):e763–7. https://doi.org/10.1016/j.jcjo.2024.01.017 . Cai C-X, Yu S-S, Xiong X-M, Liu B-Q, Lin Z-Q, Wang Q, Cui J-L, Liu Z-H, Li T, Lu L, Lin Y. Age-Related Alterations in Vortex Veins on Indocyanine Green Angiography. Geroscience. 2025;47(3):3291–8. https://doi.org/10.1007/s11357-024-01298-7 . Kogo T, Muraoka Y, Ishikura M, Nishigori N, Akiyama Y, Ueda-Arakawa N, Miyata M, Ooto S, Hata M, Takahashi A, Miyake M, Tsujikawa A. Pigment Epithelial Detachment and Leak Point Locations in Central Serous Chorioretinopathy. Am J Ophthalmol. 2024;261:19–27. https://doi.org/10.1016/j.ajo.2024.01.012 . Zarnegar A, Ong J, Matsyaraja T, Arora S, Chhablani J. Pathomechanisms in Central Serous Chorioretinopathy: A Recent Update. Int J Retina Vitreous. 2023;9(1):3. https://doi.org/10.1186/s40942-023-00443-2 . Cai C-X, Xiong X-M, Li T, Liu B-Q, Huang X-H, Yu S-S, Lin Z-Q, Wang Q, Cui J-L, Lu L, Lin Y. Vortex Vein Engorgement and Different Shapes of Venous Drainage Systems in Polypoid Choroidal Vasculopathy vs. Age–related Macular Degeneration on Indocyanine Green Angiography. Exp Ther Med. 2023;25(4):162. https://doi.org/10.3892/etm.2023.11861 . Schultz H, Bacorn C, Cristiano BC, Carey AR, Carper MG, Gailloud P, Miller NR, Campbell AA. Bilateral Dilated Superior Ophthalmic Veins in a Patient With an Arteriovenous Dialysis Fistula. Ophthalmic Plast Reconstr Surg. 2024;40(1):e19–23. https://doi.org/10.1097/IOP.0000000000002524 . Ying Sze C, Bakin S, Ismail R. Neuropsychiatric Presentation in Indirect Carotid-Cavernous Fistula: A Case Report. Cureus. 2023;15(4):e37523. https://doi.org/10.7759/cureus.37523 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Dec, 2025 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 21 Oct, 2025 Reviews received at journal 15 Oct, 2025 Reviewers agreed at journal 08 Oct, 2025 Reviews received at journal 08 Oct, 2025 Reviewers agreed at journal 08 Oct, 2025 Reviews received at journal 04 Oct, 2025 Reviewers agreed at journal 04 Oct, 2025 Reviewers invited by journal 25 Sep, 2025 Editor assigned by journal 23 Sep, 2025 Editor invited by journal 02 Sep, 2025 Submission checks completed at journal 01 Sep, 2025 First submitted to journal 01 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7427936","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":524819715,"identity":"7437381e-4c81-4eb3-9465-de38c9202f1c","order_by":0,"name":"Xiaohui Tian","email":"","orcid":"","institution":"Xinjiang 474 Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaohui","middleName":"","lastName":"Tian","suffix":""},{"id":524819717,"identity":"a3f87ce3-9340-4202-8775-e51dbf180969","order_by":1,"name":"Leibing 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08:05:25","extension":"html","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":58067,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7427936/v1/91d08bda5fdf59b6f99fc1c0.html"},{"id":93016368,"identity":"d9bedd30-be32-411e-a74b-c6920e35778c","added_by":"auto","created_at":"2025-10-08 08:05:25","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49141,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOcular Ultrasound: \u003c/strong\u003eA localized, arc-shaped echo band was observed along the inferotemporal globe wall in the left eye. No evidence of a solid tumor or calcification was detected.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7427936/v1/e33128e260b8784b666f20e2.jpeg"},{"id":93017772,"identity":"24439e35-6192-4ac6-a394-b290a37049ec","added_by":"auto","created_at":"2025-10-08 08:21:25","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":208039,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eWide-Angle Color Fundus Photography and Autofluorescence: \u003c/strong\u003eColor photography revealed a localized, purplish-red elevated lesion in the inferotemporal peripheral retina of the left eye, without hemorrhage or exudate. FAF demonstrated a corresponding dense area of low autofluorescence in the inferotemporal retina.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7427936/v1/b399f94e50668a1f728dc2a3.jpeg"},{"id":93017546,"identity":"b0a380e9-384d-477c-aa79-3dfc0a896666","added_by":"auto","created_at":"2025-10-08 08:13:25","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":126438,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIndocyanine Green Angiography (ICGA): \u003c/strong\u003eThe mid-phase image (36 seconds) showed focal, \"sac-like\" or \"tumor-like\" vascular dilatation within the inferotemporal vortex vein drainage area. The vessel diameter was significantly enlarged. Contrast agent filled uniformly without leakage. The surrounding choroidal vasculature appeared normal, with no abnormal fluorescence.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7427936/v1/7c2bc3a8b0e746e87bd1e5dd.jpeg"},{"id":93016376,"identity":"94625bfb-598d-47de-9081-703cfa6aa23b","added_by":"auto","created_at":"2025-10-08 08:05:25","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":263076,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCombined Fluorescein Fundus Angiography (FFA) and ICGA Imaging:\u003c/strong\u003e Large and medium-sized choroidal vessels were clearly delineated without significant tortuosity or dilation of branching vessels. No fluorescence leakage, vascular wall staining, or choroidal neovascularization (CNV) was observed. Choroidal capillary perfusion was uniform, without focal filling defects or fluorescence blockage.\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7427936/v1/fcfd96381ad0bba016ab0560.jpeg"},{"id":99172576,"identity":"4f2ecf18-798d-4d31-be07-177786195016","added_by":"auto","created_at":"2025-12-29 16:11:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1083643,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7427936/v1/14b13ad7-e981-49e8-968d-51a45eae41bc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Idiopathic Unilateral Vortex Vein Dilation: A Multimodal Imaging Case Report Abstract","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe vortex venous system serves as the primary drainage pathway for the choroid. Typically, 4 to 6 vortex veins collect blood flow from the choroid, iris, and ciliary body [1]. These veins are predominantly located in the superotemporal and inferotemporal quadrants, with the superotemporal quadrant acting as the main drainage route \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Originating from the choroidal capillary network, the veins converge into the ampulla before obliquely traversing the sclera at the equator and draining into the superior and inferior ophthalmic veins. Abnormal dilation of the vortex vein ampulla constitutes vortex vein dilatation (VVD).While VVD typically does not threaten vision or require treatment, its clinical significance lies in distinguishing it from sight-threatening or malignant retinal lesions, such as choroidal melanoma, nevus, metastasis, subretinal hemorrhage, or choroidal hemangioma. Characteristic fundus findings of VVD can be misdiagnosed as choroidal tumors or vascular malformations, potentially leading to unnecessary interventions. Although VVD is frequently reported in association with conditions like Sturge-Weber syndrome, carotid-cavernous fistula (CCF), or elevated intraocular pressure\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, idiopathic VVD remains rare. Previous literature lacks detailed descriptions of the multimodal imaging characteristics specific to idiopathic VVD. This case report provides high-resolution imaging evidence to support the accurate diagnosis of idiopathic VVD and its differentiation from malignant lesions and choroidal vascular pathologies.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 51-year-old male presented following the incidental discovery of an abnormal fundus finding in the left inferotemporal quadrant during a routine physical examination. The patient reported no visual impairment, metamorphopsia, or ocular pain and had no significant medical history. Best-corrected visual acuity was 20/20 in both eyes. Intraocular pressure measured 14 mmHg (OD) and 15 mmHg (OS). Anterior segment examination was unremarkable.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eMultimodal Imaging Findings\u003c/h2\u003e\u003c/div\u003e\u003cp\u003eFigure 1\u003c/p\u003e\u003cp\u003eFigure 2\u003c/p\u003e\u003cp\u003eFigure 3\u003c/p\u003e\u003cp\u003eFigure 4\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe vortex venous system is the principal drainage route for choroidal blood flow, accounting for approximately 90% of intraocular venous drainage . Balance in choroidal venous pressure is critical for vascular stability; venous drainage obstruction can lead to secondary intraocular pressure elevation and retinal perfusion abnormalities\u003csup\u003e\u0026nbsp;[4]\u003c/sup\u003e. Histologically, the wall of the vortex vein comprises three distinct layers. The innermost layer consists primarily of endothelial cells, forming a critical component of the blood-retinal barrier. The middle layer contains smooth muscle cells and elastic fibers, which regulate venous tone and contractility. Pathological proliferation or atrophy of these smooth muscle cells can disrupt venous tone regulation, impairing blood flow dynamics within the vortex vein. The outermost layer is composed of collagen fibers, elastic fibers, and other connective tissue elements, providing essential mechanical support and resistance against dilation. While this structural configuration enables the vein to withstand physiological hemodynamic forces, it may also confer an inherent susceptibility to pathological dilation\u003csup\u003e[5-7]\u003c/sup\u003e. Retrospective studies indicate that approximately 67% of VVD occurs in the scleral segment, characterized by significant diameter increase and cystic changes\u003csup\u003e\u0026nbsp;[8]\u003c/sup\u003e. Furthermore, vortex vein dilatation in this region can create high-pressure zones, potentially contributing to conditions like central serous chorioretinopathy (CSC), highlighting its anatomical vulnerability \u003csup\u003e[9]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003ePathologically, VVD manifests as focal cystic or fusiform dilation of the vortex vein lumen. The primary clinical challenge is its differentiation from other fundus pathologies, particularly choroidal malignancies, due to its characteristic purplish-red, elevated appearance. The risk of misdiagnosis is substantial. One study found that among six patients initially diagnosed with choroidal lesions (including three with choroiditis), two were ultimately diagnosed with VVD, with one-third having received unnecessary treatment \u003csup\u003e[10]\u003c/sup\u003e. A European study reviewing 715 patients initially diagnosed with choroidal melanoma found that 40.5% actually had choroidal nevi, 12% had hemorrhagic/exudative retinopathy, 10.5% had choroidal hemangioma, and 4% had age-related macular degeneration (AMD) \u003csup\u003e[11]\u003c/sup\u003e. Such misdiagnoses carry significant emotional and clinical consequences for patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe etiology of VVD includes aging, choroidal blood flow disorders, obstruction, and congestion. Aging is a significant factor; degenerative changes in the vein wall and hemodynamic alterations occur with age. Studies measuring central vortex vein diameter (CVVD), mean root area (MRAVV), and maximum branch diameter (WMTBD) show significant increases, particularly in individuals over 61 years \u003csup\u003e[12]\u003c/sup\u003e. Hemodynamic abnormalities are central to VVD pathogenesis. Conditions like CSC involve venous outflow obstruction leading to vortex vein dilatation\u003csup\u003e\u0026nbsp;[9,13-14]\u003c/sup\u003e. Similarly, polypoidal choroidal vasculopathy (PCV) exhibits significant dilation of posterior choroidal veins compared to healthy eyes\u003csup\u003e\u0026nbsp;[15]\u003c/sup\u003e. Secondary VVD also occurs in conditions like CCF, where arteriovenous shunting into the superior ophthalmic vein increases venous pressure, causing compensatory vortex vein dilatation\u003csup\u003e\u0026nbsp;[2,16,17]\u003c/sup\u003e. Isolated idiopathic VVD, lacking an identifiable systemic or ocular cause, is rarely reported. Such cases often present asymptomatically and pose a higher risk of misdiagnosis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIdiopathic VVD is exceptionally rare. In this case, we utilized wide-angle fundus photography, FAF, high-resolution ICGA, FFA, and ocular ultrasound to comprehensively characterize the lesion. These multimodal imaging findings provide crucial evidence to distinguish idiopathic VVD from mimickers such as choroidal melanoma, CSC, PCV, AMD, and other vascular lesions that may present with similar fundus features or secondary vortex vein changes. Accurate diagnosis via multimodal imaging is essential to prevent unnecessary interventions and ensure appropriate patient management.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eAll procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. \u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal. \u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. \u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo specific grant was received from any funding agency in the public, commercial, or not-for-profit sectors for the preparation of this case report. \u003cstrong\u003eCompeting interest:\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the patient for granting permission to publish this case report and for providing informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXiaohui Tian and Leibing Ji were responsible for the collection of image data and drafting the manuscript. ReYiSai Abudulamu participated in writing the manuscript. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHe G, Zhang X, Ji Y, Li M, Hao X, Zhuang X, Pu J, Mi L, Wen F. Distribution and Morphologic Characteristics of Choroidal Vortex Veins in Pachychoroid Disease. Photodiagnosis Photodyn Ther. 2024;50:104404. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.pdpdt.2024.104404\u003c/span\u003e\u003cspan address=\"10.1016/j.pdpdt.2024.104404\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFang J, Wang G, Song Y. Giant Carotid-Cavernous Fistula with Complete Shunt. 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Cureus. 2023;15(4):e37523. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7759/cureus.37523\u003c/span\u003e\u003cspan address=\"10.7759/cureus.37523\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Vortex Vein Dilation, Multimodal Imaging, Idiopathic Disease, Diagnostic Errors","lastPublishedDoi":"10.21203/rs.3.rs-7427936/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7427936/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e To report a case of idiopathic vortex vein dilatation diagnosed using multimodal imaging, including indocyanine green angiography (ICGA), sodium fluorescein angiography (FFA), wide-angle color fundus photography, fundus autofluorescence (FAF), and ocular ultrasound.\u003cbr\u003e\n \u003cstrong\u003eMethods:\u003c/strong\u003e Vortex vein dilatation is a clinically rare phenomenon, often incidentally detected during imaging. Its characteristic fundus appearance can mimic choroidal tumors or vascular lesions, potentially leading to unnecessary intervention. Current literature lacks sufficient reports of idiopathic cases and detailed descriptions of their imaging characteristics. We describe a 51-year-old male patient with an abnormal fundus finding in the left inferotemporal quadrant during routine examination. Multimodal imaging (color fundus photography, ocular ultrasound, FFA, and ICGA) excluded secondary causes, confirming a diagnosis of idiopathic cystic vortex vein dilatation.\u003cbr\u003e\n \u003cstrong\u003eConclusion:\u003c/strong\u003e Idiopathic vortex vein dilatation exhibits distinctive multimodal imaging features. These findings provide diagnostic criteria to assist clinicians in achieving an accurate diagnosis and avoiding misdiagnosis.\u003c/p\u003e","manuscriptTitle":"Idiopathic Unilateral Vortex Vein Dilation: A Multimodal Imaging Case Report Abstract","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 08:05:20","doi":"10.21203/rs.3.rs-7427936/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-21T05:33:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-15T19:18:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64452219801728288035015304811109193094","date":"2025-10-08T08:31:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-08T05:19:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206359071725047466614471089322488911321","date":"2025-10-08T05:10:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-04T13:03:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"208669794712648605021129936739788467276","date":"2025-10-04T05:46:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-25T06:26:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-23T10:14:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-02T04:20:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-01T14:14:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2025-09-01T14:09:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e11d93e4-8200-4bd6-b78b-304ff7f47965","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T16:07:58+00:00","versionOfRecord":{"articleIdentity":"rs-7427936","link":"https://doi.org/10.1186/s12886-025-04585-9","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2025-12-22 15:58:03","publishedOnDateReadable":"December 22nd, 2025"},"versionCreatedAt":"2025-10-08 08:05:20","video":"","vorDoi":"10.1186/s12886-025-04585-9","vorDoiUrl":"https://doi.org/10.1186/s12886-025-04585-9","workflowStages":[]},"version":"v1","identity":"rs-7427936","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7427936","identity":"rs-7427936","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}