Spontaneous passage of dacryoliths has been described, but it remains an exceptional event. A 40-year-old female with lacrimal sac dilatation and a suspected partial nasolacrimal duct obstruction on irrigation was advised 3D cone-beam computed tomography-dacryocystography. The contrast agent used was a viscoelastic barium sulfate. Initial immediate image evaluation revealed a distinct and sharp intraluminal filling defect at the junction of the lacrimal sac and nasolacrimal duct with an interrupted contrast column, suggestive of a dacryolith (Panel 1, A–C). Since the dense contrast further distended the lacrimal sac swelling, a compression was applied to empty the sac through regurgitation. The examiner felt a sudden release, and the patient immediately reported passage of material into the nasal cavity. Endoscopic examination showed contrast material in the nasal cavity. To confirm the suspected expulsion, a repeat 3D cone-beam computed tomography-dacryocystography was performed approximately 20 minutes later, which demonstrated the absence of any filling defect, patent lacrimal sac and nasolacrimal duct, and an uninterrupted contrast column (Panel 2, A–C). Subsequent lacrimal irrigation was patent. At the 6-month follow-up, the patient was asymptomatic. The use of a dense, viscoelastic contrast agent, combined with the lacrimal sac compression, may have facilitated the mechanical propulsion of the dacryolith. This case highlights the dual diagnostic and therapeutic potential of modern 3D dacryocystography in select cases of partial nasolacrimal duct obstruction.FIG.:
NowakMD et al. (Thu,) studied this question.