Dacryolithiasis

Case contributed by Dr Ashesh Ishwarlal Ranchod

Presentation

4 months history of unilateral right epiphora and dacrocystitis. Preoperative CT imaging.

Patient Data

Age: 60 years
Gender: Female
CT

There are multiple punctate calcified and ring like calcified dacryoliths within the symptomatic right nasolacrimal duct .

The left nasolacrimal duct is completely patent and air filled.

There was no dacryocystitis or preseptal cellulitis at time of imaging due to multiple courses of antibiotics prior to ct imaging.

CT

Reformats confirm multiple right nasolacrimal duct calcified dacryoliths and a normal and patent air filled left nasolacrimal duct.

Annotated image

Multiple annotated CT images demonstrating the right nasolacrimal duct dacryoliths on axial soft tissue and bony windows and sagittal and coronal reformats additionally.

Photo

Intraoperative image at time of dacryocystorhinostomy showing a lobulated calcified dacryolith in the opened lacrimal sac.

Specimen images confirming multiple dacryoliths of varying sizes removed at time of surgical intervention.

Case Discussion

Dacryoliths are a rare clinical finding.

They appear as focal areas of high attenuation within a soft tissue attenuation in the nasolacrimal sac or nasolacrimal duct as demonstrated above.

Occasionally they have a rim of calcification and hence the "rice kernel" appearance as in this case.

This patient underwent a unilateral right dacryocystorhinostomy at which multiple dacryoliths were confirmed and surgically removed.

In addition a stricture of the right nasolacrimal duct just proximal to the valve of Hasner was found surgically.

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