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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 846-847

Mucopeptide concretion of the nasolacrimal duct associated with dacryocystitis diagnosed by computed tomography


1 Department of Radiology, Clínica Alemana de Temuco; Department of Medical Specialties, Universidad de la Frontera, Temuco, Chile
2 Department of Medical Specialties, Universidad de la Frontera, Temuco, Chile
3 Facultad de Medicina , Universidad de la Frontera, Temuco, Chile

Date of Submission01-Dec-2020
Date of Acceptance04-Mar-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Michael Hirsch
Senador Estebanez 645, Temuco - 4810552, Region de la Araucania
Chile
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_3584_20

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  Abstract 


Keywords: Dacryocystitis, dacryolith, dacryolithiasis, nasolacrimal duct


How to cite this article:
Hirsch M, Krauss K, Gazmuri E. Mucopeptide concretion of the nasolacrimal duct associated with dacryocystitis diagnosed by computed tomography. Indian J Ophthalmol Case Rep 2021;1:846-7

How to cite this URL:
Hirsch M, Krauss K, Gazmuri E. Mucopeptide concretion of the nasolacrimal duct associated with dacryocystitis diagnosed by computed tomography. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 26];1:846-7. Available from: https://www.ijoreports.in/text.asp?2021/1/4/846/327678



A 49-year-old woman consulted for swelling of the left periorbital region associated with mucopurulent secretion. The ophthalmological assessment revealed a severe palpebral and periorbital edema, with intense pain that prevented the spontaneous opening of the eyelid. The conjunctiva was edematous and hyperemic and there was evidence of mucopurulent secretion from both lacrimal puncta. The study was continued with computed tomography (CT) of the orbits, which showed an increased thickness and density of preseptal soft tissues, associated with distension of the lacrimal sac, with enhancement of its wall after the use of contrast [Figure 1]a. A dense image was identified in the distal portion of the ipsilateral nasolacrimal duct that obstructed the lumen [Figure 1]b, [Figure 1]c, [Figure 1]d. A left dacryocystitis associated with a nasolacrimal duct mucopeptide concretion was concluded. Antibiotic treatment was indicated and a dacryocystorhinostomy was performed, wihch confirmed the diagnosis.
Figure 1: Orbit CT with contrast in the axial plane (a) shows an increase in the thickness and density of the preseptal soft tissues (arrowheads) of the left orbit, associated with distention of the lacrimal sac (arrow) and enhancement of its wall with contrast. Orbit CT without contrast in the axial plane with bone window (b) shows the mucopeptide concretion in the naso lacrimal duct (arrow). Orbit CT without contrast in the sagittal plane with bone window (c) shows the mucopeptide concretion in the naso lacrimal duct (arrow). Volume rendering technique CT (d) generated with 2 mm thick data, which generates some artifacts, however it adequately shows the mucopeptide concretion in the nasolacrimal duct (arrow)

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  Discussion Top


Lacrimal system mucopeptide concretions or dacryolithiasiscan manifest clinically when it obstructs the nasolacrimal duct, inducing epiphora, dacryocystitis, mucoid discharge through the punctum or swelling of the medial canthus, as in our case.[1] Diagnosis methods include the dacryocystography, dacryoscintigraphy, ultrasound, CT and magnetic resonance imaging.[2],[3],[4]

CT of the orbits presents several advantages in the non-invasive evaluation of obstructions of the lacrimal system, among them the visualisation of the surrounding bone structures, the structures within the orbit, the nasal and perinasal cavities, in addition to its demonstrated ability to visualize mucopeptide concretions in symptomatic patients.[5] The CT findings characteristic of mucopeptide concretions are the identification of hyperdense foci within a mass of dense soft tissue in relation to an inflamed lacrimal gland, lacrimal sac or nasolagrimal duct. These single or multiple foci can have a dense homogenous structure or present a calcified peripheral edge.[5] CT is one of the best options to evaluate the lacrimal system and its obstructive complications.[1],[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgments

We wish to thank the Office of Research at the Universidad de La Frontera for its support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mishra K, Hu KY, Kamal S, Andron A, Della Rocca RC, Ali MJ, et al. Dacryolithiasis: A review. Ophthal Plast Reconstr Surg 2017;33:83-9.  Back to cited text no. 1
    
2.
Wearne MJ, Pitts J, Frank J, Rose GVE. Comparison of dacryocystography and lacrimal scintigraphy in the diagnosis of functional nasolacrimal duct obstruction. Br J Ophthalmol 1999;83:1032-5.  Back to cited text no. 2
    
3.
Stupp T, Pavlidis M, Busse H, Thanos S. Presurgical and postsurgical ultrasound assessment of lacrimal drainage dysfunction. Am J Ophthalmol 2004;138:764-71.  Back to cited text no. 3
    
4.
Alten F, Domeier E, Holz FG, Loeffler KU. Dacryoliths in the lacrimal gland ductule. Acta Ophthalmol 2012;90:e155-6.  Back to cited text no. 4
    
5.
Asheim J, Spickler E. Case report CT demonstration of dacryolithiasis complicated by dacryocystitis. Am J Neuroradiol 2005;26:2640-1.  Back to cited text no. 5
    


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