Dacrocystocele with dacrocystitis and periorbital cellulitis
Edema/inflammatory changes within the left orbital subcutaneous
tissues. Dilated fluid-filled left lacrimal sac and duct which
display enhancing walls. No post septal inflammation or
A dacrocystocele is the second most common cause of neonatal nasal
obstruction (second to choanal atresia). It occurs secondary to
imperforate valves of Hasner (at the distal lacrimal duct) and
results in a triad of cystic medial canthal mass, dilatation of the
nasolacrimal duct and submucosal nasal cavity mass in the inferior
meatus. Patients typically present with inner canthal swelling and
epiphoria but if not detected or treated, periorbital cellulitis,
dacrocystitis or even sepsis may occur. If large enough, it may
also expand the nasal cavity causing respiratory distress.
Treatment consists of duct massage or probing with relief of
obstruction and antibiotics (if necessary). The differential for
this case would include dacrocystocele, congenital nasolacrimal
cyst or abscess. The differential for a medial nasoorbital mass
includes meningocele, encephalocele and nasal gliomas. Contrast
enhanced CT would be the modality of choice for initial evaluation.
MR would primarily be useful for evaluation of a suspected medial
Som, Peter M., Curtain, Hugh D. Head and Neck Imaging, p. 1174.
Mosby-Year Book, St. Louis, 1996.