Multimodal Imaging in an Atypical Adult-Onset Lacrimal Sac Mucocele

A 61-year-old female presented with a 2-month history of a mass in the right lacrimal sac area after a 10-year persistent epiphora accompanied by occasional ipsilateral discharge. External examination revealed a subcutaneous mass of tough quality, clear boundaries, and poor mobility. Computed tomography showed a low-density oval mass. Axial fat-suppressed T1-weighted magnetic resonance imaging (MRI) showed a slight enhancement around the mass. The special feature of this case was that the slightly high-density oval image on CT, combined with incomplete blockage on dacryography, indicated the tendency of a soft tissue tumor outside the lacrimal sac, whereas the significantly enhanced boundary on MRI was more inclined to a cystic mass. Finally, the mass was excised diagnostically, external dacryocystorhinostomy combined with polyurethane stenting was performed, and histopathology suggested lacrimal sac mucocele. Here, the authors report a rare case of atypical adult-onset lacrimal sac mucocele and emphasize the importance of multimodal imaging evaluation for surgical guidance.