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

Answer

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.

 

PHACE SYNDROME:

P-Posterior fossa brain malformation

H-Hemangiomas

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

 

Treatment;

Conservative monitoring

Steroids

Co2 laser therapy

Laryngotracheoplasty

Interferon

Vincristine

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.)





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