Case of the Week: April 1-April 8, 2010

1 year old presents with stridor

(Click for a larger image.)

Case Details

Same lesion can be seen elsewhere and can be associated with syndrome.

Asymmetric subglottic narrowing with loss of one shoulder


Diagnosis: Subglottic Hemangioma

Subglottic hemangioma posterior lateral position is most common and left >right, rarely calcify.


Hemangiomas arises by endothelial hyperplasia whereas vascular malformations arise by dysmorphogenesis and exhibit normal endothelial turnover.


Subglottic hemangiomas -1.5% congenital anomalies of the larynx.


Cutaneous hemangiomas are seen in 50% of cases.



P-Posterior fossa brain malformation


A-Arterial anomalies

C-Coarctation of aorta, cardiac defects

E-Eye abnormalities

7% have subglottic hemangiomas


Kasabach-Merritt Syndrome-Rarely associated with subglottic hemangioma. Usually seen with hemangioendothelioma of liver and with thrombocytopenia.


Differential Diagnosis:

Subglottic stenosis

Tracheal granuloma

Viral croup

Membranous croup

Tracheal papillomatosis



Conservative monitoring


Co2 laser therapy




Direct excision of subglottic hemangioma


Take Home Message:

In croup  there is symmetrical narrowing with loss of shoulders on both sides(Steepel Sign)

In subglottic hemangioma loss of shouder on one side.( See the figure and line drawing)


(Click for a larger image.)

Correct answers by users

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    VCU Department of Pediatric Radiology Virginia Commonwealth University VCU Medical Center