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Table of Contents
CASE REPORT
Year : 2012  |  Volume : 2  |  Issue : 2  |  Page : 93-94

Prenatal diagnosis of subglottic hemangioma


1 DNB Resident, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
2 Department of Laryngology and Voice, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
3 Department of Obstetrics and Gynaecology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
4 Department of Radiology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
5 Department of Pediatrics, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India

Date of Web Publication5-Feb-2013

Correspondence Address:
Sowmya Poojari
Deenanath Mangeshkar Hospital, Pune
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-9748.106991

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   Abstract 

Hemangioma is by far the most common lesion of the subglottic airway in newborn and infants. It may cause severe, even life-threatening respiratory obstruction. A definitive diagnosis is based on direct endotracheal inspection of the subglottic airway. Plain radiograph of the neck may aid in establishing the diagnosis prior to endoscopy. This is a case report of prenatal diagnosis of subglottic hemangioma by fetal MRI and its management by planned delivery and tracheostomy.

Keywords: Fetal MRI, subglottic hemangioma, tracheostomy


How to cite this article:
Poojari S, Gandhi S, Godbole G, Kulkarni A, Singh J, Godbole K. Prenatal diagnosis of subglottic hemangioma. J Laryngol Voice 2012;2:93-4

How to cite this URL:
Poojari S, Gandhi S, Godbole G, Kulkarni A, Singh J, Godbole K. Prenatal diagnosis of subglottic hemangioma. J Laryngol Voice [serial online] 2012 [cited 2021 Apr 22];2:93-4. Available from: https://www.laryngologyandvoice.org/text.asp?2012/2/2/93/106991


   Introduction Top


Subglottic hemangioma accounts for 1.5% of all congenital anomalies of the larynx. They usually obstruct the subglottis and become life threatening, as subglottis being the narrowest part of endolarynx in the pediatric age group. It is believed that subglottic hemangioma consistently show a distinctively asymmetric narrowing of the airway on frontal radiographs of the neck and that this is virtually pathognomic. [1] We herein present a case of congenital subglottic hemangioma detected by fetal MRI during the antenatal period and its planned management.


   Case Report Top


A 28-year-old primigravida was referred to our tertiary care laryngology center from the department of obstetrics. Her third trimester ultrasonography showed polyhydraminos with fetal laryngeal obstruction. A fetal MRI was done to locate the exact pathology. MRI was suggestive of high airway obstruction [Figure 1]. In view of the findings of fetal airway obstruction, elective caesarean section was done and a female baby of 2.8 kg delivered. Baby cried immediately but had labored breathing and she did not maintain saturation. An emergency tracheostomy was done followed by direct laryngoscopy (DLScopy) and examination [Figure 2]. Direct laryngoscopy showed subglottic hemangioma [Figure 3]. The baby had other congenital anomalies in the form of PDA and CTEV.
Figure 1: MRI was suggestive of high airway obstruction

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Figure 2: Tracheostomy of new born baby

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Figure 3: DL Scopy: subglottic hemangioma

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   Discussion Top


Subglottic hemangioma is a cause of severe, life threatening respiratory obstruction in infants. Females are affected twice as often as males. [2] The child is usually asymptomatic at birth and develops progressive respiratory distress within a week. Patients manifest with biphasic stridor, barking cough, normal or hoarse cry, and failure to thrive. Most patients develop airway obstruction which often requires tracheostomy. Endoscopic examination is necessary to establish a diagnosis of subglottic hemangioma. The lesion is usually located posterolaterally in the submucosa in the subglottis. The lesion is pink-blue, sessile, and easily compressible. The plain radiographs of the neck show an asymmetric narrowing of the subglottis, which may aid in establishing the diagnosis prior to endoscopy. Gradual involution of the lesion may occur after 12-18 months of age. Mortality rate reported in the literature is still high (19%). [3] Charath et al. in 2002 did a review of the management options of infantile subglottic hemangioma and concluded that requirement for tracheostomy remained unchanged over the last 20 years. [4] The treatment modalities available for subglottic hemangioma are conservative monitoring, systemic and intralesional steroids, systemic interferon, laser surgery, tracheostomy, submucus resection, and open surgery. Endoscopic laser resection is effective for subglottic hemangioma but carries risk of subglottic stenosis up to 25%. [5] Rahbar et al. in their study on the management of subglottic hemangioma concluded that the treatment should be individualized based on symptoms, clinical findings, and experience of the surgeon. [6],[7] Saetti et al. in their study concluded that the endoscopic laser surgery using a diode laser is the safest and most effective device for the treatment of congenital subglottic hemangiomas and treatment with intralesional or systemic steroids could have adjuvant role. [8] Nozawa et al. reported a case of an infant with subglottic hemangioma clearly demonstrated by MR imaging and they consider it is a promising diagnostic adjuvant to direct endoscopic examination. [1]

This case highlights the high index of suspicion that should be kept in mind while doing fetal USG. MRI is the investigation of choice for diagnosing fetal airway obstruction. Planned delivery and airway management including tracheostomy can avoid the mortality

 
   References Top

1.Nozawa K, Aihara T, Takano H. MR Imaging of a subglottic haemangioma. Pediatr Radiol 1995;25:235-6.  Back to cited text no. 1
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2.Cooper M, Solvis TL, Madgy DN, Levitsky D. Congenital Subglottic Haemangioma: Frequency of symmetric narrowing on frontal radiographs of the neck. AJR Am J Roentgenol 1992;159:1269-71.  Back to cited text no. 2
    
3.Sebestian B, Kleinsasser O. Treatment of laryngeal haemangioma in children. Laryngol Rhinol Otol 1984;63:403-7.  Back to cited text no. 3
    
4.Chatrath P, Black M, Jani P, Albert DM, Bailey CM. A Review of the current management of infantile subglottic haemangioma, including a comparison of CO2 laser therapy versus tracheostomy. Int J Pediatr Otorhinolaryngol 2002;64:143-57.  Back to cited text no. 4
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5.Bailey CM, Froehlick P, Hoeve HL. Management of subglottic haemangioma. J Laryngol Otol 1998;112:765-8.  Back to cited text no. 5
    
6.Rahbar R, Nicollas R, Roger G, Triglia JM, Garabedian EN, McGill TJ, et al. The biology and management of subglottic haemangioma: Past, present, future. Laryngoscope 2004;114:1880-91.  Back to cited text no. 6
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7.Bitar MA, Moukarbel RV, Zalzal GH. Management of congenital subglottic haemangioma: Trends and success over the past 17 years. Otolaryngol Head Neck Surg 2005;132:226-31.  Back to cited text no. 7
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8.Saetti R, Silvestrini M, Cutrone C, Narne S. Treatment of congenital subglottic haemangiomas: Our experience compared with reports in the literature. Arch Otolaryngol Head Neck Surg 2008;134:848-51.  Back to cited text no. 8
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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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