Orbit Magnetic Resonance Imaging Images of Bilateral Dacryocele

Soonchunhyang Medical Science 18(2):119-121, December 2012
pISSN: 2233-4289 I eISSN: 2233-4297
CASE REPORT
Orbit Magnetic Resonance Imaging Images of Bilateral Dacryocele
Si Hyung Lee1, Jee Ho Chang1, Jae Ock Park2
Departments of 1Ophthalmology and 2Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Korea
In this study, we present a case of bilateral dacryocele with orbit magnetic resonance imaging (MRI) images. Otherwise healthy, full
term, 46-day-old boy was referred for the evaluation of bilateral orbital mass with both eye discharge. External examination revealed
palpable bluish mass on both medial canthus. On orbit MRI images, bilateral cystic masses were visible in his both nasolacrimal
duct on T2 weighted MRI images with fluid level on left side. The size of masses had decreased after 3 days of diagnosis. There are
only few previous articles describing on MRI findings of dacryocele, especially in bilateral cases. Therefore, we are here to present
orbit MRI images of bilateral dacryocele that may be valuable to clinicians interested in congenital nasolacrimal anomalies.
Keywords: Bilateral dacryocele; Magnetic resonance image; Nasolacrimal drainage system
INTRODUCTION
evaluation of bilateral orbital mass on both medial canthus, with
yellowish eye waxes which started since 7 days of age. The parents
Dacryocele is an uncommon congenital condition of nasolacrimal drainage system with a grey bluish mass like appearance on
have visited local hospital and were instructed to compress the lacrimal sac area frequently, but the mass did not resolve.
the medial canthus, which is a result of nasolacrimal duct obstruc-
On external examination, the palpable bluish masses were seen
tion, both proximal and distal [1]. The pathogenesis of the obstruc-
on both medial canthus, with eye waxes more prominent on his
tion is the result of an upper obstruction of Rosenmuller valve and
right eye. The patient was on intravenous antibiotics and topical
lower obstruction of the Hasner valve [2]. This mechanism can
tobramycin eyedrop, and had taken orbit MRI for differential di-
lead to accumulation of fluid in lacrimal sac, resulting secondary
agnosis, to rule out other orbit and eye anomalies.
infection, which may require a prompt treatment for the obstruc-
On orbit MRI images with enhancement, we could easily observe
tion of drainage system. Other complication includes intranasal
well encapsulated lacrimal sac mass in his both nasolacrimal duct,
cysts, astigmatism induced by compression [3].
with low signal on T1- and high signal intensity on T2 weighted im-
Most frequently used imaging modality is ultrasound (US),
ages, and the size of lesions were 11.5 × 6.5 mm for right, and 11.5
which is a simple and non-invasive way of distinguishing dacryocele from other similar pathologic conditions [4], and other imag-
× 8.5 mm for left (Fig. 1). Fluid level was visible on the left side lesion (Fig. 1A, B). Since MRI findings did not show any sign of in-
ing modalities, such as computed tomography (CT) or magnetic
flammation, all antibiotic treatments were stopped, and after 3 days
resonance imaging (MRI), can also help diagnosing dacryocele
without any further management, the mass on the left had sponta-
[5,6]. In this article, we present a case of bilateral dacryocele which
neously resolved and the size was decreased on the right (Fig. 2).
showed typical findings of dacryocele in orbit MRI images.
DISCUSSION
CASE REPORT
A dacryocele usually presents as an enlarged blue cystic lacrimal
Otherwise healthy, full term, 46-day-old boy was referred for
sac at birth [1]. The nasolacrimal drainage system develops from
Correspondence to: Jee Ho Chang
Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon 420-767, Korea
Tel: +82-32-621-5426, Fax: +82-32-621-5435, E-mail:jhchang@schmc.ac.kr
Received: Jun. 6, 2012 / Accepted after revision: Dec. 11, 2012
© 2012 Soonchunhyang Medical Research Institute
This is an Open Access article distributed under the terms of the
Creative Commons Attribution Non-Commercial License
(http://creativecommons.org/licenses/by-nc/3.0/).
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119
Lee SH, et al. • MRI Images of Bilateral Darcryocele
A
B
C
Fig. 1. Orbit magnetic resonance imaging (MRI) images of bilateral dacryocele. (A-C) Bilateral lacrimal sac masses were noted on MRI images with low signal on T1and high signal on T2- weighted images. The size of masses were 11.5 × 6.5 mm for the right (white broad arrow, A-C), and 11.5× 8.5 mm for the left (narrow arrow,
A-C). Fluid level was visible on the left side.
teristics: non-invasive and radiation free. High-resolution US is
widely used for detecting any pathologic orbit and eye condition,
especially in prenatal period, and is also best chosen for differential diagnosis. A medial cystic mass, in communication with the
dilated nasolacrimal duct, in addition to the fluid and debris content, is a typical US finding of dacryocele. US may be useful in differential diagnosing, since high internal reflectivity is observed in
other mimicking condition such as dermoid cyst and hemangioFig. 2. External photograph of the patient after 3 days of diagnosis. External
photograph showing bluish palpable mass on right side medial canthus (arrow).
ma. CT and MRI are also used for diagnosing such abnormalities
involving the orbit and eye, but commonly used as secondary modality next to US. CT has the advantage of detecting any calcifica-
surface ectoderm located in the nasal and maxillary process, and
tion and bone changes, which may be observed in dermoid cysts,
canalization of the drainage system starts at week 9 [7]. Hasner
but not in dacryoceles, whereas MRI has the advantage of present-
valve level is the last barrier to canalization [7]. It is widely accept-
ing soft tissue changes, such as cystic changes, without any radia-
ed that a dacryocele is developed from the persistent membrane at
tion exposure [8]. MRI can provide evidence for differentiating
the level of this barrier and obstruction of Rosenmuller valve [2].
dacryocele from other pathologic condition with similar appear-
Fluid accumulation occurs, and secondary infection may develop.
ance by showing anatomical continuity of a medial canthal cystic
It is important to distinguish dacryocele from other similar
mass with enlarged nasolacrimal duct [10]. Since CT and MRI are
pathologic conditions, because initial treatment can be very differ-
conducted only when the diagnosis is inconclusive with US find-
ent. The pathologic conditions which can mimic dacryoceles in-
ing, there are only limited numbers of articles on CT and MRI
clude hemangioma, encephalocele, glioma, dermoid cysts, and
findings of dacryocele, with literatures on MRI descriptions espe-
malignant, and may need further imaging evaluation [8]. Also,
cially lacking.
early detection of any complication is necessary to manage pa-
In this article, we found MRI can be useful in delineating the le-
tients properly. Dacryocele without secondary infection requires
sion. Also, MRI findings can aid in characterizing the content of
only conservative approach (i.e., warm compress, massage), but
the lesion. From the low signal on T1- and high signal on T2-
when it comes to complication, such as dacryocystitis and celluli-
weighted images, we could predict that the cystic mass was filled
tis, probing and antibiotic treatment may require [9].
with mucoid material. With such advantages, MRI can be useful
Commonly, dacryocele is diagnosed with US for its safe charac120
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imaging modality to define the margin of the lesion and the charSoonchunhyang Medical Science 18(2):119-121
MRI Images of Bilateral Darcryocele • Lee SH et al.
acteristics of inner contents, aiding in differential diagnosis from
other similar anomalies. Thus, this article may provide valuable
information on orbit MRI findings of dacryocele to other clinicians
those interested in congenital nasolacrimal system anomalies.
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