Subglottic Hemangioma - Causes, Symptoms, and Treatment

Creator: Dr. Vineetha. V
Published: 2023-03-17T15:34:35

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Subglottic hemangioma is a rare vascular condition where airway obstruction occurs due to a large mass of blood vessels. Read the article to know more about it.

Written by

Dr. Vineetha. V

Medically reviewed by

Dr. Rajesh Gulati

March 17, 2023

April 6, 2023

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Contents

What Is Subglottic Hemangioma?
What Causes Subglottic Hemangioma?
Is Skin Hemangioma Common Than Subglottic Hemangioma?
What Are the Symptoms of Subglottic Hemangioma?
How Can Subglottic Hemangioma Be Diagnosed?
How Is Subglottic Hemangioma Treated?

Introduction:

Hemangioma is a benign (non-cancerous) tumor made up of blood vessels. It most commonly appears as a raised, purplish or red bump on the skin but can also occur in internal organs. Most cases of hemangioma do not spread to other body parts, but sometimes it may interfere the vital functions like vision and breathing. They are commonly seen in infants and children, and they will resolve without treatment.

What Is Subglottic Hemangioma?

Subglottic hemangioma, also known as airway hemangioma, is a benign vascular tumor that develops in the subglottic region of the larynx or voice box. The subglottis is the area between the true vocal cords and the cricoid cartilage, which is the lowest ring-shaped cartilage in the trachea. Subglottic hemangiomas are relatively rare and typically occur in infants and young children. They tend to grow rapidly for a period of 6 to 12 months, then slowly start to shrink. Although a significant number may shrink, the majority will not shrink completely. They grow quickly and cause significant airway obstruction, making it difficult for the child to breathe, eat, or speak. In severe cases, subglottic hemangiomas can lead to life-threatening respiratory distress and may require prompt medical intervention.

What Causes Subglottic Hemangioma?

Subglottic hemangioma results from abnormal growth of blood vessels in the subglottic region of the larynx.
In addition, there may be a genetic component to developing subglottic hemangioma, as it has been observed to run in families.
Hormonal imbalances, exposure to certain environmental factors, and other underlying medical conditions may also contribute to developing a subglottic hemangioma.
However, the exact cause of subglottic hemangioma remains unknown, and further research is needed to understand the underlying mechanisms.

Is Skin Hemangioma Common Than Subglottic Hemangioma?

Skin hemangiomas are much more common than subglottic hemangiomas. Subglottic hemangiomas are a relatively rare type of hemangioma and are estimated to occur in about one to two percent of infants. In comparison, skin hemangiomas are estimated to affect up to ten percent of infants. There is a strong link between subglottic and skin hemangiomas (a common form of birthmark).

Children with subglottic hemangioma frequently exhibit skin hemangiomas, or strawberry marks, on their scalp or back. Skin hemangiomas are non-cancerous and often disappear without treatment. However, subglottic hemangiomas can threaten life and may require immediate intervention due to their location in the airway.

What Are the Symptoms of Subglottic Hemangioma?

The symptoms of subglottic hemangioma vary depending on the size and location of the tumor, as well as the age of the child. Some common symptoms of subglottic hemangioma include the following:

Stridor: This is a high-pitched, wheezing sound when the child breathes. Stridor is a sign of airway obstruction and may be heard when the child is awake or asleep.
Difficulty in Breathing: Children may experience breathing difficulty, especially during physical activity or feeding.
Difficulty in Feeding: Children may have difficulty feeding and refuse to eat or drink. They may also experience coughing or choking during feeding.
Voice Changes: Children may have a hoarse voice or be unable to speak.
Sleep Disturbances: Difficulty sleeping and waking up frequently during the night due to breathing difficulties.

How Can Subglottic Hemangioma Be Diagnosed?

A subglottic hemangioma can be diagnosed with the help of medical history, physical examination, and imaging tests. The diagnostic methods include:

Medical History: A healthcare professional will inquire about the patient's symptoms, family history, and previous illnesses or surgeries.
Physical Examination: A healthcare professional will listen to the child's breathing sound and may use a lighted instrument, called a laryngoscope, to examine the larynx.
Imaging Tests: Imaging tests such as CT (computed tomography) scans, MRI (magnetic resonance imaging) scans, or ultrasound may be done to confirm the diagnosis of subglottic hemangioma. These tests can provide detailed images of the larynx, and they help to determine the size and location of the tumor.
Laryngoscopy: This procedure uses a laryngoscope to examine the inside of the larynx. Laryngoscopy may be performed under general anesthesia and can provide more detailed information about the subglottic region.
Biopsy: Biopsy may be necessary to confirm the diagnosis of subglottic hemangioma. A biopsy involves removing a small sample of the tumor for laboratory analysis.

How Is Subglottic Hemangioma Treated?

Treatment for subglottic hemangioma varies depending on the location, size of the tumor, the children's age, and overall health. The treatments options for subglottic hemangioma:

Observation: In some cases, especially in small subglottic hemangiomas that are not causing any symptoms and discomfort, the healthcare professional may recommend observation and periodic monitoring. This may suit children with mild symptoms who do not require immediate treatment.
Beta-Blockers Like Propanolol: Propranolol is often used as a primary treatment option. It narrows the blood vessels in the hemangioma and reduces its growth, leading to shrinkage. The doctor will monitor the child for 24 to 48 hours after starting Propranolol treatment to look for potential side effects.
Steroids: Corticosteroid medications like Prednisone may reduce the hemangioma's size and improve breathing. Steroids may be administered orally, intravenously, or inhaled directly into the lungs. They are usually prescribed in combination with Propanolol.
Surgical Excision: If the hemangioma is causing significant airway obstruction, surgery may be necessary to remove the tumor. Surgical excision may be performed using endoscopic or open surgical techniques, depending on the size and location of the hemangioma.
Laser Therapy: This therapy may be used to shrink the size of the hemangioma and improve breathing. During this procedure, a laser destroys the abnormal blood vessels that make up the hemangioma.
Radiation Therapy: This therapy may be used to shrink the size of the hemangioma in rare cases. This therapy uses high-energy radiation to shrink the blood vessels and reduce the tumor size.

Conclusion:

Subglottic hemangioma is a benign vascular growth that can cause significant airway obstruction in infants and young children. Early diagnosis and prompt treatment are essential to minimize serious respiratory distress risk and ensure a positive outcome. In some cases, the hemangioma may recur, requiring additional treatment. However, with proper treatment, most children with subglottic hemangiomas can fully recover and lead an everyday healthy life.

Frequently Asked Questions

1. At What Age Does Subglottic Hemangioma Typically Occur?

Subglottic hemangioma typically occurs in infants and young children, usually presenting within the first few months of life. It affects approximately 0.5 % to 2 % of newborns. The growth of the hemangioma tends to stabilize or regress around the age of 12 to 18 months. Early detection and intervention are important for managing this condition effectively.

2. Is Surgery Necessary for the Treatment of Hemangioma?

The necessity of surgery for the treatment of hemangioma depends on various factors, including the size, location, and potential complications associated with the specific case. Surgery may be recommended if the hemangioma is causing significant functional impairment, such as obstructing the airway or affecting vital structures. Other treatment options, such as medication (e.g., beta-blockers) or laser therapy, may be considered before resorting to surgery. The decision to proceed with the surgery is usually made individually, taking into account the specific circumstances and risks involved.

3. Is the Removal of Hemangioma Considered Safe?

The removal of a hemangioma is generally considered safe, but it depends on the size, location, and extent of the growth. The approach to removal may vary, including surgical excision, laser therapy, or other minimally invasive procedures. Complications such as scarring, bleeding, infection, or damage to nearby structures are rare but possible. It is important to consult with a healthcare professional experienced in treating hemangiomas to determine the safest and most appropriate course of action.

4. What Is the Most Effective Treatment Option for Hemangioma?

In many cases, infantile hemangiomas tend to involute and regress on their own without requiring intervention. However, when treatment is necessary, options may include oral medications such as beta-blockers (e.g., Propranolol), topical medications, laser therapy, or in some cases, surgical intervention. The choice of treatment is determined based on the individual characteristics of the hemangioma. It is important to consult with a healthcare professional specializing in hemangioma management to determine the most suitable treatment approach.

5. What Is the Life Expectancy Associated with Subglottic Hemangioma?

The life expectancy associated with a subglottic hemangioma is generally not affected. While subglottic hemangiomas can cause significant airway obstruction and respiratory difficulties, prompt and appropriate treatment can help manage these complications effectively. With early intervention and appropriate medical management, the prognosis for subglottic hemangioma is generally good, and most children outgrow the condition over time. It is crucial to closely monitor the growth and any associated symptoms and consult with a healthcare professional experienced in managing subglottic hemangiomas for the best possible outcome.

6. Is Subglottic Hemangioma a Significant Concern?

Subglottic hemangioma can be a significant concern due to its potential impact on breathing and airway function. The growth of the hemangioma within the subglottic region can cause narrowing or obstruction of the airway, leading to respiratory distress, stridor (noisy breathing), or difficulty in swallowing. These symptoms can be particularly concerning in infants and young children. However, with appropriate medical management and interventions, such as medication or surgical options, the majority of subglottic hemangiomas can be effectively treated, relieving the concerns associated with compromised airway function. Regular monitoring and collaboration with healthcare professionals specializing in this condition are crucial for optimal outcomes.

7. Which Medication Is Used to Eliminate Subglottic Hemangioma?

The medication commonly used to eliminate subglottic hemangioma is propranolol, which belongs to the class of beta-blockers. Propranolol effectively reduces the size and growth of hemangiomas by constricting the blood vessels that supply them. It is often administered orally. Close monitoring is necessary during treatment to ensure its effectiveness and manage potential side effects. It is important to consult with a healthcare professional specializing in treating subglottic hemangioma to determine the appropriate medication and dosage for each situation.

8. Should I Be Concerned About Subglottic Hemangioma?

If you have concerns about subglottic hemangioma, you should talk to a healthcare professional. While subglottic hemangioma can cause respiratory difficulties and other related symptoms, it is important to remember that effective treatment options are available. Early intervention and proper management can help alleviate concerns and ensure the best possible outcome. Trusting the expertise of healthcare professionals is key in addressing any concerns you may have regarding subglottic hemangioma.

9. How Can the Growth of a Hemangioma Be Halted?

Halting the growth of a hemangioma can be achieved through various treatment approaches. One commonly used method is the administration of oral medications like propranolol, which can help shrink the hemangioma and slow down its growth. Other treatment options, including laser therapy or corticosteroid injections, can also be effective in inhibiting the growth of the hemangioma. The choice of treatment is based on factors such as the size, location, and characteristics of the hemangioma. It is important to consult with a healthcare professional experienced in treating hemangiomas to determine the most appropriate course of action for halting the growth of the specific hemangioma.

10. What Is the Duration of the Growth Phase of a Hemangioma?

The duration of the growth phase of a hemangioma can vary depending on several factors, including the individual case and characteristics of the hemangioma. In general, the growth phase of an infantile hemangioma lasts for about six to 12 months. During this period, the hemangioma tends to increase in size, potentially causing concerns related to appearance and functional impact. After the growth phase, most hemangiomas enter a stable phase, followed by a gradual involution phase where they shrink and fade over time. It is important to note that the duration and phases of growth can vary among different hemangiomas, and close monitoring by a healthcare professional is essential to determine the specific timeline for each case.

11. How Common Is Subglottic Hemangioma?

Subglottic hemangioma is relatively rare, but its exact prevalence is not well-established. While it is considered uncommon, subglottic hemangioma is a significant concern due to its potential impact on airway function and respiratory difficulties. Prompt diagnosis and appropriate treatment are crucial in managing this condition effectively. Although subglottic hemangioma is not commonly encountered, healthcare professionals must know its presentation and management to ensure timely intervention and optimal outcomes for affected individuals.

12. What Are the Risks Associated with Subglottic Hemangioma?

There are risks associated with subglottic hemangioma, primarily related to its impact on airway function. The narrowing or obstruction of the airway caused by the hemangioma can lead to respiratory difficulties, including stridor and breathing problems. In severe cases, it can result in respiratory distress, which requires immediate medical attention. Additionally, the location of the hemangioma near vital structures in the neck can pose risks during surgical interventions.

13. Does Genetics Influence Subglottic Hemangioma?

Yes, subglottic hemangioma is generally considered curable. With appropriate medical intervention and treatment, such as medication (e.g., Propranolol), laser therapy, or surgical excision, the majority of subglottic hemangiomas can be effectively managed and ultimately cured. The treatment approach depends on factors such as the size, location, and extent of the hemangioma and the individual patient's specific circumstances. Early detection and intervention are key to achieving the best possible outcome.

14. Are Subglottic Hemangiomas Cancerous?

Subglottic hemangiomas are not cancerous growths. They are benign vascular tumors that occur in the subglottic airway region. While they can cause significant airway obstruction and related symptoms, subglottic hemangiomas are typically not associated with malignancy or cancer. With appropriate management and treatment, including medication or surgical interventions, subglottic hemangiomas can be effectively controlled and often regress over time. The prognosis for subglottic hemangioma is generally favorable, and most individuals achieve a complete resolution of symptoms. It is important to consult with a healthcare professional specializing in this condition for accurate diagnosis, treatment, and ongoing monitoring.

15. Is Subglottic Hemangioma Curable?

Yes, subglottic hemangioma is generally considered curable. With appropriate medical intervention and treatment, such as medication (e.g., Propranolol), laser therapy, or surgical excision, the majority of subglottic hemangiomas can be effectively managed and ultimately cured. The treatment approach depends on factors such as the size, location, and extent of the hemangioma and the individual patient's specific circumstances. Early detection and intervention are key to achieving the best possible outcome. It is important to work closely with a healthcare professional experienced in managing subglottic hemangiomas to determine the most appropriate and effective treatment plan for each case.

Sources

Dr. Rajesh Gulati

Family Physician

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