Prenatal diagnosis of bilateral dacrocystoceles

Is congenital dacryocystocele a benign, self-limited disorder? A review of the literature with four new cases

Congenital dacryocystocele (CD) is a rare disorder about which little is known. A nonsystematic review was performed with an addition of four new cases. Thirty-seven studies were reviewed. The mean gestational age at evaluation was 32 ± 1.09 weeks suggesting that CD is a disorder of late second and third trimester. The mean diameter of dacryocystocele was 7.5 ± 1 mm. The overall associated fetal anomaly rate was 10.7%. In-utero resolution, neonatal resolution, and surgical management was concluded in 62% (n = 108), 29% (n = 52), and 8% (n = 14), respectively. In conclusion, the need for surgical correction and rate of accompanying fetal anomaly was found high.

Congenital Dacryocystocele: A Major Review

PURPOSE

To provide a systematic review of the literature on congenital dacryocystoceles (CDCs) and summarize their presentations, investigations, management, and outcomes.

METHODS

The authors performed a PubMed search of all articles published in English on CDCs. Data captured include demographics, clinical presentations, investigations, management modalities, complications, and outcomes. Fourteen major series (10 or more than 10 cases) and 89 isolated case reports/series on CDCs with a collective patient pool of 1,063 were studied in detail. Specific emphasis was laid on addressing the controversial issues including initial conservative versus surgical management and the role of endoscopic evaluation.

RESULTS

Numerous terminologies have been used to describe CDC. Congenital dacryocystoceles are rare variants of congenital nasolacrimal duct obstructions and comprise of 0.1% to 0.3% of all such cases. There is a female predilection (64.2%, 683/1,063) and the mean age at presentation is at 7 days of birth. Initial conservative treatment can be a viable option in the absence of an acute dacryocystitis or a respiratory distress. Endoscopy-assisted probing appears to have better outcomes as compared with the in-office probing. Congenital dacryocystoceles with acute dacryocystitis are preferably managed with intravenous antibiotics and an early probing under endoscopy guidance to avoid missing intranasal cysts. Marsupialization is the preferred technique in the management of intranasal cysts. Silicone intubation was rarely used and has no definitive indications. Dacryocystorhinostomy is very rarely needed in the management of CDC.

CONCLUSIONS

Congenital dacryocystocele is a commonly accepted term and its use should be advocated to enhance uniformity in reporting. Endoscopic evaluation of CDC is useful in the diagnosis and treatment of associated intranasal cysts and enhances the rates of successful outcomes.

Congenital dacryocystocele: sonographic evaluation of 11 cases

PURPOSE

To report prenatal sonographic findings of congenital dacryocystocele.

METHODS

The medical records of all cases diagnosed with congenital dacryocystocele at a tertiary care center from 2003 to 2015 were reviewed retrospectively.

RESULTS

Eleven cases of congenital dacryocystocele were analyzed. No accompanying fetal anatomic anomalies where detected. Mean maternal age at evaluation was 22 years of age (range, 17-32 years). Four of 10 cases were primigravidas. The mean gestational age at evaluation was 32.6 weeks' gestational age. Ten out of 11 cases occurred in female fetuses (91%). Of the 11, 10 cases were unilateral and 1 was bilateral. The mean diameter at evaluation was 5.1 mm. Spontaneous resolution occurred in 2 cases (18%). In the remaining 9 fetuses, postnatal diagnosis of dacryocystocele were confirmed by an ophthalmologist evaluation.

CONCLUSIONS

Prenatally diagnosed congenital dacryocystocele may undergo spontaneous resolution before birth. However, a better understanding of the prenatal sonographic findings can help to appropriately orient parents of potentially affected fetuses. Referral to a pediatrician and pediatric ophthalmologist may be considered for complete evaluation and postnatal management.

A Prenatal Diagnosis of Dacryocystocele

Dacryocystocele or lacrimal duct cyst is a benign mass resulting from a congenital obstruction of the lacrimal system. These cystic masses can be detected sonographically after 30 weeks menstrual age. This case study presents ultrasound diagnosis of the dacryocystocele at 33.5 weeks menstrual age after multiple previous sonograms, demonstrating normal fetal facial anatomy.

Three-Dimensional Sonography, Tomographic Sonography Imaging, and the OmniView Algorithm

The prenatal diagnosis of congenital dacryocystocele has been reported using 2D sonographic imaging, but there are very few reports of the use of 3D sonography for this diagnosis. Two cases are presented in which 3D and Doppler sonography was helpful in determining the prenatal diagnosis. The embryologic basis of this obstruction of the nasolacrimal duct is discussed along with techniques for the prenatal diagnosis, including the potential value of 3D sonography in limiting the necessity of other prenatal testing. The importance of establishing the differential diagnosis is also discussed, as there is the possibility of the dacryocystocele being secondary to a sinonasal tumor.

Congenital Dacryocystocele: A Rare and Benign Nasolacrimal Duct Cyst Condition

Dacryocystocele is an uncommon congenital obliteration of the nasolacrimal drainage system. Based on a case diagnosed at 30 weeks gestation using two-dimensional (2D) and threedimensional (3D), its ultrasound characteristics as well as the evolution and therapeutic options applied in the scarce existing literature are described.

How to cite this article

Bonilla-Musoles F, Jimenez LC, Castillo JC. Congenital Dacryocystocele: A Rare and Benign Nasolacrimal Duct Cyst Condition. Donald School J Ultrasound Obstet Gynecol 2012;6(3):233-236.

Congenital dacryocystocele: prenatal MRI findings

BACKGROUND

Congenital dacryocystocele can be diagnosed prenatally by imaging. Prenatal MRI is increasingly utilized for fetal diagnosis.

OBJECTIVE

To present the radiological and clinical features of seven fetuses with congenital dacryocystocele diagnosed with prenatal MRI.

MATERIALS AND METHODS

The institutional database of 1,028 consecutive prenatal MR examinations performed during a period of 4 years was reviewed retrospectively. The cases of congenital dacryocystocele were identified by reading the report of each MRI study.

RESULTS

The incidence of dacryocystocele diagnosed with prenatal MRI was 0.7% (n = 7/1,028). The dacryocystocele was bilateral in three fetuses. Mean gestational age at the time of diagnosis was 31 weeks. The indication for prenatal MRI was the presence or the suspicion of central nervous system abnormality in six fetuses and diaphragmatic hernia in one. Dacryocystocele was associated with an intranasal cyst in six of ten eyes. Prenatal sonography revealed dacryocystocele in only two of seven fetuses. Of eight eyes with postnatal follow-up, four did not have any lacrimal symptoms.

CONCLUSION

Prenatal MRI can delineate congenital dacryocystocele more clearly and in a more detailed fashion than ultrasonography. Presence of dacryocystocele was symptomatic in only 50% of our patients, supporting that prenatal diagnosis of dacryocystocele might follow a benign course.

Congenital dacryocystocele: prenatal 2- and 3-dimensional sonographic findings

OBJECTIVE

The purpose of this series is to present our experience with cases of dacryocystocele diagnosed prenatally. The role of prenatal 3-dimensional sonography, as an adjunct to 2-dimensional sonography, in the prenatal assessment of these cases is emphasized.

METHODS

A retrospective review of cases was conducted. Information was obtained by reviewing the sonographic reports and medical records. Outcomes were obtained from the referring obstetricians or directly from the parents.

RESULTS

Ten fetuses had the diagnosis of a congenital dacryocystocele at a median gestational age of 30.1 weeks (range, 27-33 weeks). In 6 cases, the cystic lesion was unilateral, and in 4 it was bilateral, with a mean largest diameter at the time of diagnosis of 7.5 mm (range, 4-11 mm). There were no other associated findings. Three-dimensional sonography, carried out in 3 cases, clearly depicted the anomaly, the degree of intranasal extension, and swelling below the medial canthal area. Spontaneous resolution was documented prenatally in 5 fetuses, and 1 additional case resolved between the last prenatal scan and the delivery. There were no reported long-term complications associated with this finding, although 1 infant required probing at 2 months of age to resolve the dacryocystocele.

CONCLUSIONS

Prenatal diagnosis of dacryocystocele is straightforward. A considerable number of lesions are bilateral, and many resolve in utero spontaneously or neonatally after minimal intervention. For those not resolving by the time of the delivery, ophthalmologic or rhinologic consultation is warranted because of potential complications. Three-dimensional sonography may provide a noninvasive method for evaluating these cystic masses and may contribute to the avoidance of additional diagnostic techniques in the neonatal period.