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Clinical Problem Solving: Radiology
January 2013

Radiology Quiz Case 3: Diagnosis

JAMA Otolaryngol Head Neck Surg. 2013;139(1):98-99. doi:10.1001/jamaoto.2013.1198b

Diagnosis: Bilateral congenital dacryocystoceles

Congenital dacryocystocele, which is a rare complication of complete obstruction of the nasolacrimal apparatus during embryonic development, is commonly diagnosed in utero or during the first few weeks of life.1 Embryologically, the nasolacrimal apparatus arises from a thickening of ectodermal tissue in the naso-optic fissure between the maxillary and frontonasal recesses, with subsequent canalization of the tissue, typically reaching completion as early as the sixth intrauterine month.1,2 Incomplete distal canalization results in an imperforate membrane at the valve of Hasner, a common finding in newborns that usually quickly resolves. Persistent distal obstruction results in dacryostenosis, which is predominantly asymptomatic.2,3 In contrast, dacryocystoceles arise from an anatomical distal obstruction and a simultaneous functional valvelike obstruction at the proximal Rosenmüller valve, resulting in accumulating fluid and cystic distension of the entire nasolacrimal system. The cystic collection of fluid may grow so large that it extends into the inferior nasal meatus.1

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