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Bilateral nasolacrimal duct mucocele and dacryocystocele

Case contributed by Rania Adel Anan
Diagnosis almost certain

Presentation

One of twin female newborns presented one day after birth with difficult breathing and bilateral nasal obstruction.

Patient Data

Age: Newborn
Gender: Female

The following triad of imaging findings:

  • bilateral medial canthus homogeneous, well-defined, thin-walled masses with fluid attenuation that represent enlarged lacrimal sacs (bilateral dacryocystoceles) in contiguity with enlarged nasolacrimal duct
  • an enlarged osseous nasolacrimal canal secondary to an enlarged soft tissue nasolacrimal duct
  • an intranasal cystic mass on both sides of the nasal cavity which represent the inferior extension of the mucocele

Clinical photo shows bilateral medial canthus swellings.

Case Discussion

The patient was referred for exclusion of bilateral choanal atresia. After imaging that revealed free passage of instilled contrast medium through posterior nostrils on both sides into nasopharynx, choanal atresia was excluded and imaging findings consistent with nasolacrimal duct mucocele were detected and the newborn was re-examined clinically. Bilateral tense, blue/grey masses were noted at the medial canthus on both sides (more evident on the left side).

  • nasolacrimal duct mucocele represents cystic dilatation of the nasolacrimal apparatus secondary to proximal +/- distal obstruction of the nasolacrimal duct
  • dacryocystocele, although rare, is the second most common cause of neonatal nasal obstruction after choanal atresia
  • may be unilateral (75%) or bilateral (25%) and have no sex predilection

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