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Neonatal Respiratory Distress Due to Bilateral Dacrocystoceles
INSIGHTS
Neonatal Respiratory Distress Due to Bilateral Dacrocystoceles previously healthy full-term female was admitted at 9 days of age with fever, grunting, and poor feeding. Cultures of her blood, urine, and cerebrospinal fluid were obtained, and empiric antibiotic therapy was initiated. Her bacterial cultures were negative, but she exhibited oxygen desaturation, necessitating supplemental oxygen by nasal cannula on the day after admission. Her lung examination was normal, as was a chest X-ray. Over the next 4 days, the patient’s supplemental oxygen requirement increased progressively, and an enlarging lesion was detected near her left medial canthus that externally resembled a blocked nasolacrimal duct (Figure 1A). Attempts to decrease the size of this lesion by external massage were unsuccessful, and attempted passage of a nasopharyngeal suction catheter to clear her nasal secretions was blocked bilaterally. Thus, bedside nasal endoscopy was performed, which demonstrated bilateral airway obstruction. Computed tomography scans revealed large bilateral dacrocystoceles (Figure 1B, asterisks), with a mass effect on both globes (Figure 1B, arrows). These dacrocystoceles extended into and obstructed the nasal cavities (Figure 1C, asterisks), displacing the inferior turbinates (Figure 1C, arrows). Bilateral dacrocystorhinostomy was performed, and nasolacrimal stents were placed without complication. After drainage, the patient’s respiratory status improved quickly, and she was weaned off supplemental oxygen within 2 days. Her mild hypertelorism present since birth was found to be improved at follow-up. Dacrocystocele is the second-leading anatomic cause of neonatal nasal obstruction and can lead to respiratory distress in neonates, who are obligate nose-breathers. Dacrocystoceles result from diffuse dilation and mucocele formation of the lacrimal system due to imperforate valves of Hasner and are bilateral in approximately 10% of cases. Up to 85% of the smaller lesions resolve spontaneously within the first several months of life; however, larger lesions often require surgical drainage.
A
Indi Trehan, MD, MPH, DTM&H Department of Pediatrics Washington University in St. Louis St. Louis, Missouri Brian K. Turpin, DO Department of Pediatrics Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio J Pediatr 2008;153:438 0022-3476/$ - see front matter Copyright © 2008 Mosby Inc. All rights reserved. 10.1016/j.jpeds.2008.03.042
438
Figure. A, Infant with expanding lesion near her left medial canthus resembling blocked nasolacrimal duct. B, Axial and C, coronal computed tomography images demonstrating bilateral dacrocystoceles.
Neonatal Respiratory Distress Due to Bilateral Dacrocystoceles previously healthy full-term female was admitted at 9 days of age with fever, grunting, and poor feeding. Cultures of her blood, urine, and cerebrospinal fluid were obtained, and empiric antibiotic therapy was initiated. Her bacterial cultures were negative, but she exhibited oxygen desaturation, necessitating supplemental oxygen by nasal cannula on the day after admission. Her lung examination was normal, as was a chest X-ray. Over the next 4 days, the patient’s supplemental oxygen requirement increased progressively, and an enlarging lesion was detected near her left medial canthus that externally resembled a blocked nasolacrimal duct (Figure 1A). Attempts to decrease the size of this lesion by external massage were unsuccessful, and attempted passage of a nasopharyngeal suction catheter to clear her nasal secretions was blocked bilaterally. Thus, bedside nasal endoscopy was performed, which demonstrated bilateral airway obstruction. Computed tomography scans revealed large bilateral dacrocystoceles (Figure 1B, asterisks), with a mass effect on both globes (Figure 1B, arrows). These dacrocystoceles extended into and obstructed the nasal cavities (Figure 1C, asterisks), displacing the inferior turbinates (Figure 1C, arrows). Bilateral dacrocystorhinostomy was performed, and nasolacrimal stents were placed without complication. After drainage, the patient’s respiratory status improved quickly, and she was weaned off supplemental oxygen within 2 days. Her mild hypertelorism present since birth was found to be improved at follow-up. Dacrocystocele is the second-leading anatomic cause of neonatal nasal obstruction and can lead to respiratory distress in neonates, who are obligate nose-breathers. Dacrocystoceles result from diffuse dilation and mucocele formation of the lacrimal system due to imperforate valves of Hasner and are bilateral in approximately 10% of cases. Up to 85% of the smaller lesions resolve spontaneously within the first several months of life; however, larger lesions often require surgical drainage.
A
Indi Trehan, MD, MPH, DTM&H Department of Pediatrics Washington University in St. Louis St. Louis, Missouri Brian K. Turpin, DO Department of Pediatrics Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio J Pediatr 2008;153:438 0022-3476/$ - see front matter Copyright © 2008 Mosby Inc. All rights reserved. 10.1016/j.jpeds.2008.03.042
438
Figure. A, Infant with expanding lesion near her left medial canthus resembling blocked nasolacrimal duct. B, Axial and C, coronal computed tomography images demonstrating bilateral dacrocystoceles.