Acute Fatal Upper Airway Obstruction from an Occult Cavernous Hemangioma of the Larynx

Abstract

A 42-year-old previously well man collapsed while holding his throat. Resuscitation was unsuccessful, and at autopsy, the most significant findings were limited to the larynx, pharynx, and anterior mediastinum where there were multinodular dark blue tumors. Within the larynx, the lower border of the tumor was well demarcated, not extending beyond the vocal cords. A separate large polypoidal tumor mass was attached to the right aryepiglottic fold by a thin fibrous stalk. Histologic examination revealed numerous large, thin-walled cavernous-type vascular spaces typical of a multifocal cavernous hemangioma. Death was due to asphyxiation from obstruction of the upper airways by a cavernous hemangioma of the larynx. Adult laryngeal hemangiomas are rare and are usually supraglottic. This case demonstrates that pedunculated laryngeal cavernous hemangiomas may remain occult until the initiation of an obstructive episode with sudden collapse and death. In such instances, the diagnosis must rely upon an autopsy examination.

Vocal cord cavernous hemangioma – Case report

“…The phonation sign of Menzel, which consists of increased firmness, erection, and deepening color of the growth during phonation, may be of diagnostic value [1]. The principal symptom is hoarseness, occasional hemoptysis, and in advanced cases dysphagia and difficult breathing [4]. No active treatment is advised for adult laryngeal hemangiomas unless the lesions are symptomatic or show a tendency to involve other parts.…”

Lethal Laryngopyocele

“…Airway narrowing may also be exacerbated by the effects of narcotic analgesics, hemorrhage, or an unusual position of the neck and head . Lesions may result in stridor and airway obstruction prior to the lethal episode or may be clinically silent . Both viral and bacterial infections such as infectious mononucleosis, Ludwig angina, acute epiglottitis, and parapharyngeal or lingual abscesses may compromise the upper airways at all ages .…”

Hemangioma cavernoso laríngeo en adultos: Reporte de un caso y revisión de la literatura

“…Si bien la mayoría de las veces se presenta como síntomas no severos y de presentación lar-vada, algunas veces los síntomas progresan hasta llegar al compromiso respiratorio 3 , incluso pueden llevar a la muerte súbita por asfixia, con un mayor riesgo cuando son lesiones pediculadas 11 . Muy rara vez, los hemangiomas se pueden comportar de forma agresiva 3 .…”

“…Se han utilizado distintas opciones de tratamiento, tales como corticoides sistémicos, corticoides o alcohol intralesionales, ablación con láser, interferón, microdebridador, radioterapia criocirugía o cirugía abierta 1,2,5,9,11 . No existe un procedimiento quirúrgico óptimo universalmente aceptado por lo infrecuente de la patología y la falta de series de casos 5 .…”