Purpose: To report a case with choroidal metastasis simultaneously diagnosed with lung adenocarcinoma in a 63-year-old male patient who was admitted for severe dyspnea and visual loss in the right eye. Case summary: A 63-year-old male patient was referred to the ophthalmology clinic due to visual deterioration of the right eye over 3 months. He was admitted to the department of pulmonology due to severe dyspnea. Best-corrected visual acuity (BCVA) was perception of hand movement in the right

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... . Fundus examination showed a creamy white choroidal mass involving the macula in the right eye. Fluorescein angiography showed a hypofluorescent lesion corresponding to the choroidal mass in the early phase and heterogeneously hyperfluorescent in the late phase. Indocyanine green angiography showed hypofluorescence throughout the phases, with an underlying isofluorescent background. Spectral domain optical coherence tomography showed an irregular, bumpy anterior surface of the choroidal mass and subretinal fluid. B-scan ultrasonography showed medium-high reflectivity of the subretinal mass. Under the impression of choroidal metastasis, we performed systemic work-up for his severe dyspnea, resulting in diagnosis of lung adenocarcinoma with brain metastasis. One month after systemic chemotherapy, BCVA was improved to 20/40. Subretinal fluid was nearly resolved, with flattening of the choroidal mass. With systemic chemotherapy, BCVA in the right eye was maintained for 3 months, and subretinal fluid was completely resolved. However, the patient died 3.5 months after diagnosis. Conclusions: Choroidal metastasis can be associated with visual deterioration and may be diagnosed before or concurrently with diagnosis of primary lung cancer.