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Answers: 2009 Series : June 16, 2009
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To see views enlarged, click on the individual pictures...
| This newborn (one week old) boy presented with a tense swelling below the left medial canthus as shown in the photo above. He was the product of a normal pregnancy and delivery. There are no other apparent physical abnormalities. |
| 1. |
The most likely diagnosis is: |
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d -- dacryocele
This is the typical appearance of a congenital dacryocele.
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| 2. |
A common associated finding in this type of case is: |
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a -- respiratory distress
These patients can have respiratory distress from a nasal mucocele. Patients who present this way should have nasal endoscopy. This cyst can be marsupialized or just decompressed at the time of probing.
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| 3. |
Treatment for this condition includes: |
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e -- all of the above
All of these procedures are appropriate depending on the choice of the treating physician and unique features of an individual case. |
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In JAAPOS, 2000 Feb;4(12):46-53: Management and complications of congenital dacryocele with concurrent intranasal mucocele. Paysse EA, Coats DK, Bernstein JM, Go C, and deJong AL.
"Conclusion: Congenital dacryoceles are commonly associated with intranasal mucoceles, dacryocystitis, and preseptal cellulitis. Respiratory distress is common in unilateral cases. Bilateral nasolacrimal duct probing should be considered in (apparent) unilateral cases because of the high incidence of occult contralateral involvement." |
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The case presented here was treated initially with incision and drainage of the cyst as shown here. For definitive treatment, probing must be done in these cases. |
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Also to be considered when diagnosing a congenital dacryocele is the possibility that this swelling could be due to a meningocele. A meningocele is more likely to be midline and is not associated with epiphora and is not likely to be secondarily infected in an infant who is otherwise not in distress. The main differential point is the midline location and the lack of epiphora, but it can also be confirmed with imaging, something that is not always readily available. The differential can be made by making pressure over the mass and observing reflux from the punctum. Encephalocele is encountered much less frequently than dacryocele. However, the editor (EMH) did treat a child in referral who was reported by the local ophthalmologist to have had bouts of “brain fever” after probing. This case was later confirmed at imaging have an encephalocele.
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