Fluorescein angiography of a 38-year-old woman shows a 'smokestack' pattern of hyperfluorescence — an early focal hyperfluorescent dot with upward expansion into an umbrella configuration. What is the most likely diagnosis?

• A Central serous chorioretinopathy ✓
• B Central retinal artery occlusion
• C Vogt-Koyanagi-Harada disease
• D Polypoidal choroidal vasculopathy

Explanation

The 'smokestack' pattern on FFA — focal early hyperfluorescence at the RPE leak point expanding upward into an umbrella or mushroom shape — is pathognomonic of central serous chorioretinopathy (CSC). This occurs as fluorescein dye leaks into the subretinal space and rises due to convection currents. VKH shows multiple pinpoint leaks, and PCV shows polypoidal orange-red lesions.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.