OP-13 A rare lesion detected on the fetal face in the 3rd trimester dacryocyctocele

Objective

Congenital dacryocystocele is a rare benign disease that presents as a cystic mass on the lacrimal sac at birth. These lesions, which are usually detected incidentally at 30 weeks of gestation, may cause parental anxiety if the  prenatal diagnosis is uncertain.

Case

A 23-years-old, 32 weeks and 1 day G3P1T1Y1 patient was referred to our outpatient clinic due to a cystic lesion on the fetal face. The patient’s history was unremarkable and no consanguinity with her wife. In the ultrasound of the patient, a well-defined, thin-walled, 12x10 mm, anechoic cystic structure was observed on the medial side of the right eyeball of the fetus(fıgure 1). Evaluated in favor of dacryocystocele. There were no additional ultrasonographic features. TORCH infection were negative. The patient’s NIPT test result, which was performed at an external center at the 15th week of pregnancy due to maternal anxiety, was normal karyotype. Fetal Magnetic Resonance (MR) imaging result was reported as consistent with dacryocystocele. The pregnancy of the patient continues at 38 weeks and she is followed up by our clinic. There is no change in lesion size and appearance.

Conclusion

The canalization of the lacrimal duct begins around the 12th week and is not completed until the 24th week. Therefore, fetal ultrasound scans before 27 weeks of gestation are usually normal in these cases. Congenital dacryocystocele diagnosed prenatally may resolve spontaneously before birth. In rare cases, a dacryocytocele may be associated with other genetic or anatomical anomalies. It is important to rule out other causes of periorbital cystic lesions. Atypical cases may benefit from MRI. Although congenital dacryocystoceles are benign, newborns must breathe through the nose, and when the lesions are large and occur bilaterally, the obstruction may cause respiratory distress in the newborn. A better understanding of prenatal sonographic findings can help optimize perinatal care of potentially affected fetuses and appropriately orient their parents.

Keywords

Dacryocystocele, preorbital cyct, ultrasound

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	Fig.1 Ultrasonographic view of dacriocystocele medial to right eyeball in axial section of fetal face