Congenital dacryocystocele diagnosed by antenatal ultrasonography with spontaneous resolution / Dacriocistocele congênita diagnosticada por ultrassonografia pré-natal com resolução espontânea

ABSTRACT Dacryocystocele is a rare benign facial abnormality of the nasolacrimal system, which may be detected at the antenatal workup during the third trimester of pregnancy. Ultrasound is the method of choice for this examination. However, magnetic resonance imaging may also be used in selected cases. Dacryocystocele is mostly a transient finding; it may resolve spontaneously in utero or postnatally. When the defect is bilateral and persists in neonatal life, it may lead to respiratory complications. We report a case of a fetus with bilateral dacryocystocele diagnosed by prenatal ultrasound at the beginning of the third trimester of pregnancy with spontaneous postpartum resorption.

RESUMO A dacriocistocele é uma anormalidade facial benigna rara do sistema nasolacrimal, que pode ser detectada na rotina pré-natal durante o terceiro trimestre da gravidez. O ultrassom é o método de escolha, mas a ressonância magnética também pode ser usada em casos específicos. Na maioria das vezes, a dacriocistocele é um achado temporário, que pode se resolver espontâneamente ainda no útero ou após o nascimento. Quando a anormalidade é bilateral e persiste na vida neonatal, pode levar a complicações respiratórias. Este é o relato do caso de um feto com dacriocistocele bilateral diagnosticada por ultrassom pré-natal no início do terceiro trimestre da gravidez, com reabsorção espontânea após o nascimento.

Valor del ultrasonido en el diagnóstico de los tumores del saco lagrimal / Value of the ultrasound in the diagnosis of lacrimal sac tumor

RESUMEN Los tumores del saco lagrimal son extremadamente raros, y el benigno primario más común es el papiloma escamoso. Clínicamente se manifiestan como una zona de tumefacción en la región cantal medial, asociado a epifora y dacriocistitis crónica-recurrente. Dentro de las pruebas de imagen recomendadas están: dacriocistografía, tomografía computarizada, resonancia magnética y dacrioescintifotografía. Sin embargo, muy pocos sugieren el uso del ultrasonido. Se presenta el caso de un papiloma mixto del saco lagrimal diagnosticado por ultrasonido. Se trata de una paciente femenina de 39 años, quien fue remitida por cuadros repetidos de dacriocistitis derecha en los últimos 3 años. En consulta se constató celulitis preseptal ipsolateral, por lo que se indicó antibiótico-terapia, y se logró la remisión de los signos inflamatorios agudos, pero persistió el aumento del volumen cantal medial derecho. La vía lagrimal se exploró y se comprobó que estaba obstruida. Se realizó ultrasonido, donde el saco lagrimal derecho apareció ocupado por una masa ecogénica, que se extendía al conducto lacrimonasal y mostraba ligera vascularidad. Seguidamente se hizo tomografía computarizada, y se confirmaron los hallazgos ecográficos, pero sin lograr delimitar la lesión intrasaco descrita, aún tras la administración de contraste yodado endovenoso. Se sugirió dacriocistitis crónica derecha, secundaria al tumor intrasaco de aspecto benigno, probable papiloma, por lo que se efectuó cirugía y examen histopatológico que ratificaron dicho diagnóstico. En conclusión, el ultrasonido del saco lagrimal es un método complementario de gran valor, que en algunos casos hará el diagnóstico, y en otros brindará información que optimizará la decisión de quienes serían tributarios a estudios más complejos(AU)

ABSTRACT Lacrimal sac tumors are extremely rare, and the most common benign primary is squamous papilloma. Clinically, they manifest as a zone of swelling in the medial canthal region, associated with epiphora and chronic-recurrent dacryocystitis. Among the recommended imaging tests are dacryostography, computed tomography, magnetic resonance imaging, and dacryoscintifotography. However, very few suggest the use of ultrasound. The case of a mixed papilloma of the lacrimal sac diagnosed by ultrasound is presented. This is a 39-year-old female patient, who was referred for repeated cases of right dacryocystitis in the last three years. In consultation, ipsolateral preseptal cellulitis was found, for which antibiotic therapy was indicated, and the remission of acute inflammatory signs was achieved, but the increase in right medial canthal volume persisted. The lacrimal duct was explored and found to be obstructed. Ultrasound was performed, where the right lacrimal sac appeared occupied by an echogenic mass, which extended to the lacrimal duct and showed slight vascularity. Subsequently, computed tomography was performed, and the ultrasound findings were confirmed, but without defining the described intrasaccal lesion, even after administration of intravenous iodinated contrast. It was suggested chronic right dacryocystitis, secondary to apparently benign intrasaccal tumor, probable papilloma, so surgery and histopathological examination were performed, which that ratified the diagnosis. In conclusion, ultrasound of the lacrimal sac is a complementary method of great value, which in some cases will make the diagnosis, while in others it will provide information that will optimize the decision of those who would be candidate to more complex studies(AU)

Ultrasound parameters of normal lacrimal sac and chronic dacryocystitis / Parâmetros ultrassonográficos do saco lacrimal normal e na dacriocistite crônica

ABSTRACT Purpose: To compared the ultrasound findings of the lacrimal sac between subjects with normal lacrimal systems those with chronic dacryocystitis. Methods: A retrospective study of 10 subjects with a normal lacrimal system (Group 1) and 10 with chronic dacryocystitis (Group 2) diagnosed according to B-mode ultrasound with a 10-MHz transducer and the direct-contact technique (AVISO, Quantel Medical) for lacrimal sac assessment. We analyzed the dimensions, features, and content of the sacs. Characteristics of the population: female: 6, Group 1; 8, Group 2; mean age 48.4 years (SD=19.9; range, 22-80 years), Group 1; 50.5 years (SD=15.5; range, 25-75 years), Group 2. Results: The dimensions of the lacrimal sac were as follows: anteroposterior 1.86 and 10.99 mm in Groups 1 and 2, respectively, p<0.0001; vertical 9.79 and 14.13 mm in Groups 1 and 2, respectively, p=0.049. Qualitative evaluation of the lacrimal sac contents showed hypoechogenic content in Group 1 (10, 100%) and hyperechogenic punctiform content in Group 2 (10, 100%) with partial filling in seven cases (70%). Conclusions: Ultrasonography can differentiate normal lacrimal sacs from sacs compromised by chronic dacryocystitis, thus being useful as an adjunct to clinical examination and surgical planning.

RESUMO Objetivo: Categorizar os achados ultrassonográficos do saco lacrimal em indivíduos com via lacrimal normal e em portadores de dacriocistite crônica. Métodos: Estudo retrospectivo de 20 indivíduos, 10 com via lacrimal normal (Grupo 1) e 10 com diagnóstico de dacriocistite crônica (Grupo 2) utilizando ultrassonografia modo B com transdutor de 10 MHz e técnica de contato (Aviso, Quantel Medical) para avaliar o saco lacrimal. Analisamos os seguintes parâmetros: dimensões, características e conteúdo. Resultados: Características da população estudada: sexo feminino: 6, Grupo 1; 8, Grupo 2; idade média: 48,4 anos (DP=19,93; variação, 22 a 80 anos), Grupo 1; 50,5 anos (DP=15,47; variação, 25 a 75 anos), Grupo 2. As dimensões do saco lacrimal foram aferidas: anteroposterior, 1,86 mm no Grupo 1 e 10,99 mm no Grupo 2, p<0,0001; vertical, 9,79 mm no Grupo 1 e 14,13 mm no Grupo 2, p=0,049. A avaliação qualitativa do conteúdo do saco lacrimal mostrou: conteúdo hipoecogênico no Grupo 1 (10, 100%); e conteúdo puntiforme hiperecogênico no Grupo 2 (10, 100%), com preenchimento parcial em 7 casos (70%). Conclusão: A ultrassonografia foi capaz de diferenciar a via lacrimal normal da acometida por dacriocistite crônica, e de determinar parâmetros úteis para suportar o acompanhamento clínico ou auxiliar no planejamento cirúrgico.

Lacrimal Intrasaccal Cyst

No abstract available.