Orbital venous malformation masquerading as lacrimal mucocele

Pandey, Nidhi

doi:10.4103/ijo.ijo_122_21

Cited by 2 publications

(3 citation statements)

References 11 publications

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“…The diagnosis was based on clinical examination, being anterior to the MCT, in line with angular vein, mobile, and patent lacrimal drainage. Pandey 17 reported a case of venous malformation (VM) simulating a dacryocystocele. The diagnosis was intraoperative as the lesion was a bluish soft tissue mass not communicating with the lacrimal system.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Isolated case reports on vascular masses in the lacrimal sac area have been published. [12][13][14][15][16][17] In most previous case reports, the lesion was identified preoperatively by their clinical characteristics and on imaging.…”

Section: Inferomedial Vascular Massesmentioning

confidence: 99%

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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“…The venous lesion was encountered during planned DCR in one patient. 15 Topical or systemic antibiotics were used without effect in 19% (4/21) of the patients without thrombophlebitis. Pain or tenderness was experienced by 43.5% (10/23) of patients, including the 2 individuals with thrombophlebitis.…”

Section: Casementioning

confidence: 99%

Disorders of the Angular Vein

Custer

Boulos

2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: The angular vein extends between the supraorbital and supratrochlear veins superiorly and the facial vein inferiorly. Rarely, this vessel can be involved by infections, vascular malformations, or benign tumors. In this study, we report both our experience and the published literature on angular vein disorders. Methods: A retrospective study was performed on patients seen between 2008 and 2022. The medical literature was searched for reports of conditions affecting the angular vein. Results: During the study period, we encountered 5 patients with angular vein disorders. Information from these patients was combined with 18 published cases. Among the 23 patients, the diagnosis was confused with lacrimal drainage abnormalities in 52%, and 57% underwent imaging. “Swelling” or a palpable, moveable mass were frequent findings. Pain or tenderness was experienced by 43.5% of patients. Five patients were observed, and 2 infections were treated with antibiotics. The remaining 16 lesions were successfully treated with excision (n = 15) or cauterization (n = 1), without complications. Final diagnosis included 14 vascular malformations (isolated varix: 7, thrombosis: 6, cavernous venous malformation: 1), 7 vascular tumors (intravenous pyogenic granulomas: 6, intravascular papillary endothelial hyperplasia: 1) and thrombophlebitis (n = 2). Conclusions: Disorders of the angular vein are uncommon and frequently misdiagnosed as lacrimal abnormalities. While these lesions can frequently be identified on clinical findings, imaging can be helpful in some cases. Patients with suspected thrombophlebitis require urgent antibiotic therapy. Minimally symptomatic angular vein lesions can be observed. Surgical excision is effective in treating the different vascular malformations and tumors affecting this structure.

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Orbital venous malformation masquerading as lacrimal mucocele

Cited by 2 publications

References 11 publications

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

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

Disorders of the Angular Vein

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