Abstract
Subglottic hemangioma is a rare but life- threatening condition which requires intervention. It generally starts proliferating in the first and second months of lifespan and whether there is a respiration problem or not, it causes biphasic stridor. Its diagnosis generally requires direct laryngoscopy or direct screening through bronchoscopy. This case report presents a 45-day-old girl who had subglottic hemangioma presenting with wheezing and stridor. Our case took propranolol with a dose of 2 mg/kg/day and within 48 h after the start of the treatment, obstructive symptoms started to alleviate considerably.
1
Introduction
Congenital subglottic hemangioma is a rarely seen lesion; however, because of its anatomical location, it can potentially cause death. It makes up 1.5% of all congenital laryngeal anomalies and it is twice more common in girls than in boys . 50% of the patients who have subglottic hemangioma have a comorbid skin hemangioma while 1%–2% of the patients who have skin hemangioma have a comorbid subglottic lesion . Hemangiomas generally regress after a proliferative phase of three to nine months and they restrict themselves. However, hemangiomas which have subglottic location require intervention since they can threaten life . This paper presents a 1,5-month-old girl who was diagnosed to have subglottic hemangioma and who was treated with propranolol.
2
Case reports
A 1.5-month-old girl who had no previous complaints was taken to our clinic with a complaint of respiratory distress. Her history revealed that she had been healthy previously; her respiratory distress and wheezing had started about 15 days ago. She had been taken to a hospital where she was diagnosed to have bronchiolitis and she had been hospitalized and treated; however, as she did not respond to the treatment, she had been sent to our hospital. Her physical examination showed that she had no cyanoses but she looked unsettled. Her respiratory rate was 64/min, her peak heart rate was 128/min and her armpit temperature was 36.6 °C. She had intercostal and subcostal retractions. Both lungs had equal contribution to respiration, respiratory sounds were coarse and she had both inspiratory and expiratory stridors which were more obvious on bilateral sibilant rales, and inspiratory phase. She also had wheezing. The examinations of her circulatory system and other systems were normal.
Laboratory test results were as follows: haemoglobin: 10.1 g/dl, hematocrit: 30.9%, white blood cell count: 6390/mm 3 , thrombocyte count: 523,000/mm 3 , Na: 138 mEq/L, K: 5.2 mEq/L, Cl: 109 mEq/L, AST: 47 IU/L, ALT: 37.5 IU/L, eosinophil 2.9%, C-reactive protein: 2.1 mg/L, IgG: 3.6 g/L, IgA: 0.19 g/L, IgM: 0.337 g/L, IgE: 10 IU/mL. Her immunoglobulin values were normal for her age and her complete urine analysis and blood gas analysis were normal. Her posteroanterior chest radiography did not show any peculiarities. She was prediagnosed as acute laryngotracheobronchitis and she started to have beta agonist, cold-vapor, nebuliser adrenaline and systemic steroid treatment. Her follow-up showed that she was not responding to treatment and her respiratory distress was increasing, thus she had a diagnostic bronchoscopy and she was found to have subglottic hemangioma ( Fig. 1 ). Tracheostomy was performed and 2/mg/kg/day oral propranolol was started. Two days after the propranolol treatment started, her complaints regressed and her clinical findings completely improved and she was discharged on the tenth day of the treatment.
2
Case reports
A 1.5-month-old girl who had no previous complaints was taken to our clinic with a complaint of respiratory distress. Her history revealed that she had been healthy previously; her respiratory distress and wheezing had started about 15 days ago. She had been taken to a hospital where she was diagnosed to have bronchiolitis and she had been hospitalized and treated; however, as she did not respond to the treatment, she had been sent to our hospital. Her physical examination showed that she had no cyanoses but she looked unsettled. Her respiratory rate was 64/min, her peak heart rate was 128/min and her armpit temperature was 36.6 °C. She had intercostal and subcostal retractions. Both lungs had equal contribution to respiration, respiratory sounds were coarse and she had both inspiratory and expiratory stridors which were more obvious on bilateral sibilant rales, and inspiratory phase. She also had wheezing. The examinations of her circulatory system and other systems were normal.
Laboratory test results were as follows: haemoglobin: 10.1 g/dl, hematocrit: 30.9%, white blood cell count: 6390/mm 3 , thrombocyte count: 523,000/mm 3 , Na: 138 mEq/L, K: 5.2 mEq/L, Cl: 109 mEq/L, AST: 47 IU/L, ALT: 37.5 IU/L, eosinophil 2.9%, C-reactive protein: 2.1 mg/L, IgG: 3.6 g/L, IgA: 0.19 g/L, IgM: 0.337 g/L, IgE: 10 IU/mL. Her immunoglobulin values were normal for her age and her complete urine analysis and blood gas analysis were normal. Her posteroanterior chest radiography did not show any peculiarities. She was prediagnosed as acute laryngotracheobronchitis and she started to have beta agonist, cold-vapor, nebuliser adrenaline and systemic steroid treatment. Her follow-up showed that she was not responding to treatment and her respiratory distress was increasing, thus she had a diagnostic bronchoscopy and she was found to have subglottic hemangioma ( Fig. 1 ). Tracheostomy was performed and 2/mg/kg/day oral propranolol was started. Two days after the propranolol treatment started, her complaints regressed and her clinical findings completely improved and she was discharged on the tenth day of the treatment.
