Imaging Techniques in the Diagnosis of Lacrimal Sac Diverticulum

Abstract

Lacrimal sac diverticulum is a rare condition characterized by a cystic structure communicating with the sac. This abnormality may be directly demonstrated by dacryocystography only in a few cases; in the remaining cases, preoperative diagnosis may be arduous. We report 3 cases of lacrimal sac diverticulum. In all patients, symptoms were represented by a palpable mass in the lacrimal sac region, associated with permanent (case 1) or episodic (cases 2 and 3) epiphora. In the first case, CT-dacryocystography revealed an apparently solid mass causing inferior lacrimal obstruction, and ultrasonography disclosed a cystic space, not communicating with the sac. At surgery, a sac diverticulum was identified and excised. In the second patient, CT showed a homogeneous rounded mass, whereas a cystic character was revealed by T₁-weighted MRI. Dacryocystography showed a lateral impression on the lateral wall of the sac. Ultrasonography revealed a cystic space communicating with the lacrimal sac. In the third case, ultrasonography demonstrated a diverticulum. CT is often unable to discriminate tumors from lacrimal cysts, both showing a parenchymal density. MRI can differentiate lacrimal cystic spaces from solid tumors by T₁ intensity and by demonstration of their walls, but it is nonspecific for diverticula. Only dacryocystography and B-scan ultrasonography can reveal the narrow communication between the sac and the diverticulum. Observation is the recommended management for asymptomatic cases.

Magnetic resonance dacryocystography: Its role in the diagnosis and treatment plan of lacrimal drainage system obstructions

“…The lens is one of the most sensitive organs to radiation [8,17]. Bilaterally, the lens is exposed to radiation inevidently in all tests used for nasolacrimal system imaging, except for MR-DCG [18]. Etiopathological factors such as mucosal thickening, mucocele, scar tissue or tumor causing stenosis in the nasolacrimal system may be visualized with MR-DCG.…”

Orbital Epithelial Cyst Derived from the Lacrimal Sac

“…Computed tomography is often unable to discriminate tumors from lacrimal cysts, both showing a parenchymal density [7]. Magnetic resonance imaging can differentiate lacrimal cystic spaces from solid tumors by T1 intensity and by demonstration of their walls, but it is not specific for diverticula [7, 8].…”

“…Magnetic resonance imaging can differentiate lacrimal cystic spaces from solid tumors by T1 intensity and by demonstration of their walls, but it is not specific for diverticula [7, 8]. Only dacryocystography and B-scan ultrasonography can reveal the narrow communication between the sac and the diverticulum.…”

Multilobular Lacrimal Sac Diverticulum Presenting as a Lower Eyelid Mass

“…The pathology may cause epiphora, discharge, pain, and result in a fluctuating mass and cutaneous erythema. Usually, such a diverticulum is asymptomatic and is occasionally diagnosed with dacryocystography [2]. The lacrimal sac diverticulum may be of congenital, inflammatory, or traumatic origin [3].…”