Diab Mostafa Mohammed, Ali Mohammad Javed, Mohammed Khaled Kotb
Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt.
Govindram Seksaria Institute of Dacryology, L V Prasad Eye Institute, Hyderabad, India.
Eur J Ophthalmol. 2023 Jan;33(1):152-160. doi: 10.1177/11206721221120152. Epub 2022 Aug 10.
Several non-lacrimal lesions can present with lacrimal sac area swelling mimicking a dacryocystocele or mucocele with a possibility of misdiagnosis. This study investigates the clinic-radiologic characteristics of the mimicking conditions compared to true lacrimal sac distension.
Retrospective, comparative, interventional case series.
Patients referred by primary care ophthalmologists between January 2015 and October 2021 with a misdiagnosis of dacryocystocele or lacrimal sac mucocele (n = 39) and an age-matched group of proven true lacrimal sac swelling (TLS group, n = 44).
Data collected included demographics, presenting features, investigations, management, histopathology, and outcomes. Both groups were statistically compared for several clinical and radiological variables.
Final diagnoses in the mimicking group were skin/subcutaneous swellings (14/39, 35.9%), vascular malformations (10/39, 25.6%), inferomedial anterior orbital cysts (7/39, 17.9%), sino-orbital masses (5/39, 12.8%). Female gender (<0.001), epiphora (p = 0.001), and discharge (p < 0.001) were significantly more frequent in the TLS group. The mimicking group was more likely to be associated with a longer swelling duration (p < 0.001), a swelling extending beyond the lacrimal sac area (p <0.001), orbital signs (p <0.001), and periorbital abnormality. Non-patent lacrimal irrigation (p < 0.001) was significantly more frequent in the TLS group. On imaging, all swellings in the mimicking group were separate from the lacrimal pathway and 94.9% (37/39) extended beyond the lacrimal sac fossa.
Various cutaneous, subcutaneous, vascular, inferomedial orbital cystic, and sinonasal pathologies can present with lacrimal sac area swelling and mimic a TLS. A high index of suspicion, a thorough clinical evaluation and proper imaging are essential to avoid a misdiagnosis.
几种非泪腺病变可表现为泪囊区肿胀，类似泪囊膨出或黏液囊肿，有可能导致误诊。本研究调查了这些类似情况与真正泪囊扩张相比的临床放射学特征。
回顾性、对比性、干预性病例系列研究。
2015年1月至2021年10月期间由初级保健眼科医生转诊的被误诊为泪囊膨出或泪囊黏液囊肿的患者（n = 39），以及年龄匹配的经证实为真正泪囊肿胀的一组患者（TLS组，n = 44）。
收集的数据包括人口统计学信息、临床表现、检查、治疗、组织病理学和结果。对两组的几个临床和放射学变量进行统计学比较。
在类似组中的最终诊断为皮肤/皮下肿胀（14/39，35.9%）、血管畸形（10/39，25.6%）、眶内下前部囊肿（7/39，17.9%）、鼻窦眶肿物（5/39，12.8%）。TLS组中女性（<0.001）、溢泪（p = 0.001）和分泌物增多（p <0.001）的情况明显更常见。类似组更可能与肿胀持续时间较长（p <0.001）、肿胀超出泪囊区（p <0.001）、眼眶体征（p <0.001）和眶周异常有关。TLS组中泪道冲洗不通畅（p <0.001）的情况明显更常见。在影像学上，类似组中的所有肿胀均与泪道分开，94.9%（37/39）超出泪囊窝。
各种皮肤、皮下、血管、眶内下囊性和鼻窦病变可表现为泪囊区肿胀并类似真正的泪囊肿胀。高度的怀疑指数、全面的临床评估和适当的影像学检查对于避免误诊至关重要。
