Subglottic hemangioma in an infant

Patient LM, born on 27 dec 2020, full gestational age, female. Presented with progressive inspiratory distress at 8 weeks of postnatal age. Emergency intubation due to extreme respiratory distress, desaturation, and tachycardia 189/min, despite Oxygen supplement up to 4l/m, not responding to venous steroids therapy. After intubation, inspiratory distress was resolved immediately. Extubated successfully after 2 days. Patient continued clinically with stridor nonresponding to steroids. X rays of the neck and of the thorax were normal.

Fibrolaryngoscopy at 10 weeks revealed a subglottic mass on the left side on the subglottic area (Figure1).

Start of propranolol 2mg/ kg, as a monotherapy. Stridor improved after 10 days; Stridor free 1 month after therapy with propranolol as monotherapy started.

Fibrolaryngotracheoscopy at 8 months old, revealed resolution of hemangioma (Figure 2).

Background

Hemangiomas are benign capillary tumors, which occur in newborns on a rate 1-2%, usually in skin. Sometimes they occur in airways and in ¼ of them they have a skin hemangioma as well.

Discussion

CO₂ laser, Neodym-Yag laser, and tracheostomy are listed a treatment method, leavin scars, strenosis and delay and difficulties speaking [1]. Airways hemangiomas that respond to propranolol treatment are 86% [2]. Dramatic and fast response was observed in some studies [3] this is one of them. Decided to continue therapy with propranolol as a monotherapy up to 9 month old. Catch up growth of hemangiomas are reported in 7% of cases. Some authors recommend continuing propranolol up to 12 months to prevent regrowth.

None.

No conflict of interest.