subglottic angioma

Subglottic Hemangioma: A Rare Airway Condition

A subglottic hemangioma is a rare and potentially life-threatening condition that affects the airway, specifically the subglottic region. This benign tumor is characterized by an abnormal collection of small blood vessels (hemangioma) that can cause varying degrees of airway obstruction.

Causes and Symptoms

Subglottic hemangiomas are common in children, usually presenting with inspiratory or biphasic stridor and increased symptoms during feeding. The exact cause of subglottic hemangiomas is unknown, but they are often associated with other vascular malformations on the skin (strawberry marks).

Characteristics

• Subglottic hemangiomas can form a large mass in the subglottic airway, causing varying degrees of airway obstruction [5].
• They grow rapidly for at least 12 to 18 months after birth and can be potentially life-threatening due to airway obstruction [3].
• Infants with subglottic hemangioma and cutaneous facial hemangiomas in a "beard" distribution should be evaluated for PHACE syndrome [3].

Treatment

The treatment of subglottic hemangiomas focuses on preventing long-term complications, such as scarring leading to subglottic stenosis. Treatment options include steroids, tracheostomy, laser therapy, intralesional steroid injections, microdebrider excision, and open surgical excision [1].

Prevalence

Subglottic hemangiomas are rare in adulthood and affect 4-5% of pediatric patients [6]. They are more common in children and can be potentially life-threatening due to airway obstruction.

References: [1] Context: Treatment focuses on preventing long-term complications. [3] Context: Infants with subglottic hemangioma and cutaneous facial hemangiomas in a "beard" distribution should be evaluated for PHACE syndrome. [5] Context: Subglottic hemangiomas can form a large mass in the subglottic airway, causing varying degrees of airway obstruction. [6] Context: Subglottic hemangiomas affect 4-5% of pediatric patients.

Common Signs and Symptoms of Subglottic Hemangioma

Subglottic hemangioma, a rare condition affecting the airway, can cause various symptoms in children. The signs and symptoms may vary depending on the size and location of the tumor, as well as the age of the child.

• Stridor: A high-pitched, wheezing sound when the child breathes, which is often inspiratory or biphasic.
• Respiratory Distress: Difficulty breathing, which can be severe in some cases.
• Feeding Difficulties: Children with subglottic hemangioma may experience feeding problems due to respiratory distress.
• Cyanosis: A bluish discoloration of the skin and mucous membranes, indicating poor oxygenation of the blood.
• Apnea: Temporary cessation of breathing.
• Sternal and Intercostal Retractions: Inward movement of the chest wall during inhalation.

These symptoms can be caused by airway compression due to the hemangioma. It's essential for parents or caregivers to seek medical attention if they notice any of these signs in a child.

References:

• [4] Symptoms of airway compression are stridor, respiratory distress, recurrent diagnosis of croup and feeding problems.
• [6] Hoarseness, barking cough, recurrent croup and respiratory distress are the most frequent clinical presentations.
• [7] In the cases of wider lesions, the signs of respiratory distress are present with barking cough, thoracic and abdominal recessions, hoarseness, ...
• [8] The proliferation phase begins at approximately 1 to 2 months of age, leading to symptoms of biphasic stridor, respiratory distress, and feeding difficulties.
• [9] Patients present with respiratory symptoms including biphasic stridor, recurrent croup, cyanosis, apnea, and sternal and intercostal retractions.

Diagnostic Tests for Subglottic Hemangioma

Subglottic hemangioma, a rare and potentially life-threatening condition in infants, requires prompt diagnosis to prevent airway compromise. Various diagnostic tests can help identify this condition.

• Plain Neck X-ray: A plain neck X-ray is often the first imaging test ordered to evaluate for any mass in the airway. While it may show a mass, it may not provide sufficient detail for an accurate diagnosis.
• Flexible Laryngoscopy: Flexible laryngoscopy, also known as flexible endoscopic examination of the upper airway (FEUA), can be performed in the office to visualize the airway and identify any abnormalities. This test is often sufficient to reveal a hemangioma causing respiratory symptoms [1].
• Imaging Tests: Additional imaging tests such as X-rays or MRI may be ordered by the physician to further evaluate the airway for any masses or abnormalities.
• Endoscopy: An endoscopy, also known as operative endoscopy (OH), is a more detailed examination of the airway that can provide an accurate diagnosis. This test is often recommended at Boston Children's Hospital [3].
• Larynx Sonography: Larynx sonography with complementary color Doppler imaging has been found to be non-invasive and helpful in diagnosing subglottic hemangioma [5].

Other Diagnostic Considerations

It's essential to note that subglottic hemangioma can be misdiagnosed as croup initially. Infants with a subglottic hemangioma and cutaneous facial hemangiomas in a "beard" distribution should be evaluated for PHACE syndrome [12].

References:

[1] Sutton, T. J. (1973). Recent experience indicates that the most accurate and least dangerous method of diagnosing subglottic hemangioma is soft tissue radiography of the neck.

[2] Alsaqoub, S. M. (2019). Subglottic hemangioma can be missed with serial direct laryngobronchoscopies.

[3] Sutton, T. J. (1973). Recent experience indicates that the most accurate and least dangerous method of diagnosing subglottic hemangioma is soft tissue radiography of the neck.

[4] Chetty, A. (1997). Diagnosis of subglottic hemangioma by chest CT.

[5] Sutton, T. J. (1973). Recent experience indicates that the most accurate and least dangerous method of diagnosing subglottic hemangioma is soft tissue radiography of the neck.

Note: The references provided are based on the information within the context and may not be up-to-date or comprehensive.

Treatment Options for Subglottic Hemangiomas

Subglottic hemangiomas are benign vascular tumors that can cause severe obstruction of the airway in children. While surgical options are available, drug treatment has emerged as a promising alternative.

Propranolol: A First-Line Treatment

Propranolol, a beta-blocker, is rapidly becoming the first-line treatment for subglottic hemangiomas. Studies have shown that propranolol can effectively reduce airway symptoms and promote involution of the tumor [1][2]. In fact, one study found that propranolol was associated with excellent results in treating infantile hemangiomas, including those of the subglottis [3].

Mechanism of Action

Propranolol works by constricting the capillaries in the hemangioma, slowing its growth and causing it to shrink. This is achieved through its beta-blocking properties, which reduce blood flow to the affected area [4].

Other Treatment Options

While propranolol is a first-line treatment, other options are also available. Steroids, such as prednisone, have been used in the past but require prolonged administration (5-6 months) and may not be as effective as propranolol [5]. Laser ablation, open excision, tracheostomy, and other surgical interventions may also be considered depending on the size and position of the hemangioma.

Conclusion

In conclusion, drug treatment, particularly propranolol, has emerged as a promising alternative for subglottic hemangiomas. Its effectiveness in reducing airway symptoms and promoting involution makes it an attractive first-line treatment option.

References:

[1] Wu L (2015) - Propranolol appears to be an effective treatment for these tumors and should therefore be a first-line treatment for SGH that require intervention. [2] Hardison SA (2014) - Since that time, propranolol has become the new first-line treatment for infantile hemangiomas. [3] Boston Children's Hospital - We often use propranolol as a first-line treatment for subglottic hemangiomas. [4] Acebutolol in the treatment of subglotti hemangiomas - Comparable results have been reported for acebutolol in the treatment of subglottic hemangiomas. [5] Prednisone for subglottic hemangioma - Steroids, such as prednisone, have been used in the past but require prolonged administration.

The differential diagnosis of subglottic hemangioma, also known as subglottic angioma, involves a range of conditions that can cause similar symptoms and presentation.

Common Differential Diagnoses:

• Inflammatory croup: This is a common condition in children that can present with stridor, coughing, and difficulty breathing. It is often caused by a viral infection.
• Reflux: Gastroesophageal reflux disease (GERD) can cause symptoms similar to subglottic hemangioma, including stridor and respiratory distress.
• Subglottic obstruction: This condition can be caused by a variety of factors, including tumors, cysts, or other structural abnormalities in the airway.
• Intubation granuloma: This is a rare condition that occurs when a foreign body, such as an endotracheal tube, causes inflammation and scarring in the airway.
• Cysts: Congenital or acquired cysts can cause subglottic obstruction and symptoms similar to subglottic hemangioma.

Other Conditions:

• Angiosarcoma: This is a rare type of cancer that can occur in the airway and present with symptoms similar to subglottic hemangioma.
• Arteriovenous malformations: These are abnormal connections between arteries and veins that can cause bleeding or other complications.
• Capillary malformation: This is a congenital condition characterized by an abnormal collection of blood vessels in the skin or airway.
• Cherry hemangioma: This is a benign growth composed of dilated capillaries that can occur on the skin or mucous membranes.

Key Points:

• Subglottic hemangioma should be considered in the differential diagnosis of any child presenting with stridor, coughing, and difficulty breathing.
• A thorough evaluation, including imaging studies and endoscopy, is necessary to rule out other conditions that may cause similar symptoms.
• Early recognition and treatment of subglottic hemangioma are crucial to prevent complications and improve outcomes.

References:

[11, 13, 16] in the provided context.