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Congenital Dacryocystocoele with Prenatal Diagnosis Gracinda Nogueira Oliveira,1 Miguel Branco,2 Lina Ramos,3 Dolores Faria Pereira4

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Congenital Dacryocystocoele with Prenatal Diagnosis Gracinda Nogueira Oliveira,1 Miguel Branco,2 Lina Ramos,3 Dolores Faria Pereira4 Images in… BMJ Case Reports: first published as 10.1136/bcr-2016-215641 on 10 May 2016. Downloaded from Congenital dacryocystocoele with prenatal diagnosis Gracinda Nogueira Oliveira,1 Miguel Branco,2 Lina Ramos,3 Dolores Faria Pereira4 1Department of Paediatrics, DESCRIPTION Hospital Pediátrico de Coimbra, A male term infant was born to a 32-year-old Portugal 2Department of Gynaecology primigravida after conception induced by in vitro and Obstetrics, Maternidade fertilisation. The mother had experienced an Bissaya Barreto, Coimbra, uneventful prenatal course until the routine third Portugal 3 trimester ultrasound screening, at the 35th-week of Department of Medical gestation, revealed a hypoechogenic cystic Genetics, Hospital Pediátrico de Coimbra, Portugal 12×12 mm mass on the right inferior medial 4Department of Neonatology, orbital wall of the fetus, with no blood flow Maternidade Bissaya Barreto, detected on Doppler ultrasound (figure 1). These Coimbra, Portugal initial findings suggested a dacryocystocoele. An Correspondence to infant boy was delivered vaginally with a birth Gracinda Nogueira Oliveira, weight of 3060 g. Apgar scores were 10 at 1 and [email protected] 5 min. No initial respiratory nor feeding difficulties were perceived. Physical examination revealed only Accepted 24 April 2016 a bluish cystic mass in the medial canthal region of the child’s right eye, measuring 8×6 mm (figure 2). He was admitted for routine care. During his stay, breathing and breastfeeding occurred unevent- fully and the isolated cystic mass remained unchanged. Ophthalmology collaboration estab- lished the diagnosis of dacryocystocoele, indication for conservative care was given and a follow-up consultation arranged. The aetiology, treatment and alarm signs for complications were carefully Figure 2 Newborn infant with a firm bluish cystic mass explained to both parents prior to discharge measuring 8×6 mm, corresponding to a dacryocystocoele (4 days after birth). of the right eye, located in the inner canthal area, Seventeen days after discharge, a scant bilateral demonstrating upward slanting of the palpebral fissure. purulent discharge was noted, conjunctivitis was diagnosed and topical azithromycin initiated. Two http://casereports.bmj.com/ 23 days later, on follow-up, the newborn was asymp- neonatal period, as in this case. Doppler ultra- tomatic and the dacryocystocoele resolved com- sound is a non-invasive method used to reliably dis- pletely after manual massage performed by a tinguish dacryocystocoeles from other pathological paediatric ophthalmologist. At 1 year the child conditions, such as haemangioma, dermoid cyst 12 remains well. and nasal glioma. Dacryocystocoeles typically Congenital dacryocystocoele is a rare type of lac- present as firm bluish swellings inferomedial to the 12 rimal duct obstruction (0.1%), caused by a prox- medial canthus. Associated clinical complica- imal and distal obstruction of the nasolacrimal tions, including dacryocystitis, periorbital cellulitis drainage system, resulting in a cystic distension of and respiratory distress, require systemic antibiotics – 1 1 3 the lacrimal sac. It is a benign lesion that typically or surgical management. Accurate prenatal diag- on 1 October 2021 by guest. Protected copyright. resolves spontaneously in utero or in the early nosis is important as it enables adequate postnatal follow-up. Learning points ▸ Dacryocystocoele is a rare congenital condition and ultrasound is an important diagnostic tool, contributing to the differential diagnosis with other masses. ▸ Spontaneous resolution is common, reinforcing conservative treatment; nevertheless, To cite: Oliveira GN, infection-related complications require Branco M, Ramos L, et al. Figure 1 Prenatal ultrasound examination at 35 weeks antibiotic treatment and, eventually, surgical BMJ Case Rep Published gestation demonstrating (on axial view) a hypoechogenic intervention. online: [please include Day cystic mass of the right inferior medial orbital wall ▸ Appropriate referral and parental education is Month Year] doi:10.1136/ measuring 12×12 mm (arrow). D, dacryocystocoele; LE, essential on follow-up. bcr-2016-215641 left eye; RE, right eye. Oliveira GN, et al. BMJ Case Rep 2016. doi:10.1136/bcr-2016-215641 1 Images in… BMJ Case Reports: first published as 10.1136/bcr-2016-215641 on 10 May 2016. Downloaded from Contributors GNO conducted the literature search and wrote the article. MB REFERENCES performed the obstetric ultrasound examinations. MB, LR and DFP contributed to 1 Kim YH, Lee YJ, Song MJ, et al. Dacryocystocele on prenatal ultrasonography: the drafting, revision and final approval of the article. diagnosis and postnatal outcomes. Ultrasonography 2015;34:51–7. Competing interests None declared. 2 Li SL, Luo GY, Tian XX, et al. Prenatal diagnosis and perinatal outcome of congenital dacryocystocele: a large case series. Prenat Diagn 2015;35:103–7. Patient consent Obtained. 3 Bonilla-Musoles F, Jimenez LC, Castillo JC. Congenital dacryocystocele: a rare and benign – Provenance and peer review Not commissioned; externally peer reviewed. nasolacrimal duct cyst condition. Donald School J Ultrasound Obstet Gynecol 2012;6:233 6. Copyright 2016 BMJ Publishing Group. All rights reserved. For permission to reuse any of this content visit http://group.bmj.com/group/rights-licensing/permissions. BMJ Case Report Fellows may re-use this article for personal use and teaching without any further permission. Become a Fellow of BMJ Case Reports today and you can: ▸ Submit as many cases as you like ▸ Enjoy fast sympathetic peer review and rapid publication of accepted articles ▸ Access all the published articles ▸ Re-use any of the published material for personal use and teaching without further permission For information on Institutional Fellowships contact [email protected] Visit casereports.bmj.com for more articles like this and to become a Fellow http://casereports.bmj.com/ on 1 October 2021 by guest. Protected copyright. 2 Oliveira GN, et al. BMJ Case Rep 2016. doi:10.1136/bcr-2016-215641.
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