Endoscopic resection of a huge orbital ethmoidal mucocele masquerading as dacryocystocele

Wong, Eugene; Leith, Nicholas; Wilcsek, Geoff; Sacks, Raymond

doi:10.1136/bcr-2018-226232

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…Visualization of orbital lesions is still based on pre-surgery image assessment of two-dimensional (2D) data visualization on a computer monitor or on intraoperative exploration 12 , 13 . There are increasing possibilities for presentation and interaction with virtual reality 14 .…”

Section: Introductionmentioning

confidence: 99%

Validation of virtual reality orbitometry bridges digital and physical worlds

Maloca

Faludi

Żelechowski

et al. 2020

Sci Rep

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Clinical science and medical imaging technology are traditionally displayed in two dimensions (2D) on a computer monitor. In contrast, three-dimensional (3D) virtual reality (VR) expands the realm of 2D image visualization, enabling an immersive VR experience with unhindered spatial interaction by the user. Thus far, analysis of data extracted from VR applications was mainly qualitative. In this study, we enhance VR and provide evidence for quantitative VR research by validating digital VR display of computed tomography (CT) data of the orbit. Volumetric CT data were transferred and rendered into a VR environment. Subsequently, seven graders performed repeated and blinded diameter measurements. the intergrader variability of the measurements in VR was much lower compared to measurements in the physical world and measurements were reasonably consistent with their corresponding elements in the real context. The overall VR measurements were 5.49% higher. As such, this study attests the ability of VR to provide similar quantitative data alongside the added benefit of VR interfaces. VR entails a lot of potential for the future research in ophthalmology and beyond in any scientific field that uses three-dimensional data. Orbital tumors can either be primary, arising from structures within the orbit, or secondary, due to metastatic spread of a primary tumor elsewhere 1-3. A myriad of clinical findings suggest the presence of an orbital mass, namely proptosis, diplopia, pain, conjunctival congestion and varying degrees of visual loss 4,5. Diagnosis relies on adequate clinical examination and orbital imaging like magnetic resonance imaging (MRI) and/or computed tomography (CT) 6. Despite the great progress in medical imaging, the diagnosis of orbital lesions based on neuroimaging features may lack characteristic imaging features. Often, the diagnosis of specific orbital disorders such as Graves' disease associated orbitopathy, orbital inflammation, orbital lymphoma, lacrimal gland epithelial tumor, metastatic carcinoma, and vascular orbital lesions is ambiguous 7-10. Confirmation of the diagnosis frequently relies on a biopsy which can be technically challenging and prone to complications due to the dense arrangement of tissue or inaccessibility of many of these lesions 11. Visualization of orbital lesions is still based on pre-surgery image assessment of two-dimensional (2D) data visualization on a computer monitor or on intraoperative exploration 12,13. There are increasing possibilities for presentation and interaction with virtual reality 14. In this context, virtual reality (VR) has recently been optimized as an enhanced medical image display method and showed to safeguard visual comfort 15,16. The main objective of this study was to extend current medical image display and validate the level of spatial precision in orbitometry of CT data, representing the physical world, compared to precision in three-dimensional (3D) virtual reality for the first time. This is especially important when new ways are explored to use ...

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Section: Introductionmentioning

confidence: 99%

Validation of virtual reality orbitometry bridges digital and physical worlds

Maloca

Faludi

Żelechowski

et al. 2020

Sci Rep

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“…Wong et al . 24 reported a case of large anterior ethmoid mucocele mistaken as dacryocystocele on initial radiological evaluation. The patient underwent combined endoscopic resection and a DCR.…”

Section: Discussionmentioning

confidence: 99%

“…The mimickers' group demonstrated the swelling as separate from the lacrimal sac and the NLD in all the cases but extended beyond the lacrimal sac fossa in 94.9% (37/39). The CT scan internal characteristics were cystic and homogeneous in 41.0% (16/39) and 61.5% (24), respectively. Bone erosion was present in 41.0% (16/37).…”

Section: Radiologic Featuresmentioning

confidence: 96%

Clinico-radiologic characteristics of lacrimal sac area swellings misdiagnosed as dacryocystocele or mucocele

Diab

Ali

Mohammed

2022

European Journal of Ophthalmology

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Purpose 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. Design Retrospective, comparative, interventional case series Participants 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). Methods Data collected included demographics, presenting features, investigations, management, histopathology, and outcomes. Both groups were statistically compared for several clinical and radiological variables. Results 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. Conclusion 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.

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