Section 4b

An 8 year old boy presents to paediatric ED with stridor. Previously on intubation for a benign elective procedure an anaesthetist noted a red mass in the sub-glottis. 

What is the diagnosis?

  • Subglottic haemangioma

What investigation is required to accurately diagnose and manage the patient?

  • Microlaryngoscopy

How else might this patient present?

 

  • Cough
  • Shortness of breath

What is the first line treatment option for this condition?

Intravenous propranolol

List two side effects with this treatment.

  • Bradycardia
  • Hypotension
  • Hypoglycaemia
  • Bronchospasm

Supporting information

Haemangioma– absent at birth, rapidly increases in size and then reduces at 18 months due to apoptosis. They can cause bleeding, infection and platelet depletion in Kasabach-Merritt syndrome (haemangioma and thrombocytopenia). 

Treated with beta-blockers and steroids medically. If causing compression- visual field defects then surgically treated. 

Vascular malformations

  • High flow- neurosurgery
  • Low flow venous- ENT- 
    • Lymphatic
    • Cystic hygroma- lymphatic-venous malformations- posterior triangle- treated with surgical excision or sclerosing agents such as bleomycin, doxycycline, ethanol.
    • Capillary / venular – port wine stain- laser or make-up
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