Journal Information
Vol. 98. Issue 6.
Pages 479-480 (01 June 2023)
Vol. 98. Issue 6.
Pages 479-480 (01 June 2023)
Images in Paediatrics
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Intratracheal infantile haemangioma: an infrequent cause of lower airway obstruction in early infancy
Hemangioma infantil intratraqueal: obstrucción de la vía aérea inferior en la infancia
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Javier Arredondo Montero
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, Ada Yessenia Molina Caballero, Julio Cesar Moreno, Giuseppa Antona
Pediatric Surgery Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
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An 11-month-old girl presented with recurrent bronchitis. A chest radiograph evinced a lesion at the tracheal level. Computed tomography (CT) scan showed a supracarinal nodular enhancing-lesion that obstructed 50% of the tracheal lumen (Fig. 1). Based on radiological findings, the diagnostic suspicion of airway infantile haemangioma (AIH) was established and treatment with oral propranolol was initiated. A fibrobronchoscopy performed at 24 h detected features compatible with AIH (Fig. 2A). Follow-up assessments by means of fibrobronchoscopy at 1 and 5 months showed a marked reduction in the size of the lesion (Fig. 2B). In infants presenting with lower airway obstruction, the differential diagnosis must include AIH. While benign, this disease can be life-threatening.1 Early diagnosis and treatment are essential. When AIH is strongly suspected, empiric treatment with propranolol should be initiated even if the diagnosis has yet to be confirmed.2 Regarding diagnosis, some authors have described the use of CT.3 However, the use of fibrobronchoscopy avoids radiation exposure. Propranolol is the first-line treatment for AIH and is associated with a lower rate of complications compared to surgery.1

Figure 1.

Computed tomography. Near complete obstruction of the tracheal lumen by a solid enhancing lesion (white arrow). To facilitate the interpretation of the image, the volume that corresponds to the AIH has been highlighted in red. Pattern of consolidation-atelectasis in most of the right upper lobe with air bronchogram causing mild ipsilateral tracheal displacement.

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Figure 2.

Bronchoscopy images of the lesion. A: at diagnosis. B: after 5 months of treatment with oral propranolol. Note the marked decrease in size of the lesion.

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References
[1]
M. Corbeddu, D. Meucci, A. Diociaiuti, S. Giancristoforo, R. Rotunno, M.V. Gonfiantini, et al.
Management of upper airway infantile hemangiomas: experience of one italian multidisciplinary center.
[2]
J.C. Moreno Alfonso, A.Y. Molina Caballero, A. Pérez Martínez, J. Arredondo Montero, J. Zubicaray Ugarteche, C. Bardají Pascual.
[Cranio-facial-cervical and subglottic hemangioma with respiratory symptoms. A therapeutic emergency].
An Sist Sanit Navar., 44 (2021), pp. 113-117
[3]
J. Choi, S.A. Im, J.Y. Kim.
Submucosal hemangioma of the trachea in an infant: diagnosis and follow-up with 3D-CT/bronchoscopy.
Iran J Pediatr., 26 (2016),
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