Postcricoid Hemangioma of Childhood: Report of Four Cases

Abstract

Hemangiomas are the most common tumor of infancy, and the vast majority occur in the head and neck region. In children, laryngeal hemangiomas typically occur below the level of the true vocal folds, in the region of the subglottis, and other sites are exceedingly rare. We present four cases of hemangiomas located in the postcricoid region of the hypopharynx. Because of the location of these lesions, children may present with obstructive symptoms such as dysphagia, intermittent aspiration, hypersalivation, or recurrent respiratory infections. Clinical diagnosis is relatively easily made with flexible laryngoscopy, as the lesions have a propensity to enlarge with crying or straining. When these patients are examined under general anesthesia in a relaxed state, however, the lesions are typically much smaller, and can even go unnoticed. Unlike other reported cases, the postcricoid hemangiomas in our patients were not causing any symptoms and were simply incidental findings. Thus, we believe that the true incidence of postcricoid hemangiomas is likely higher than reports suggest. To our knowledge, we report the longest follow-up (6 years) of a patient with a postcricoid hemangioma and are the first to describe the natural course of such a lesion.

Postcricoid vascular abnormalities: Hemangiomas, venous malformations, or anatomic variant

“…Review of the literature yielded nine reports in which a total of 30 patients were presented; 40 patients, including our series [1][2][3][4][5][6][7][8][9]. In six reports, the finding was felt to represent a hemangioma, and three felt they were a vascular lesion, more specifically a venous malformation.…”

“…One minute, 48 second video stroboscopy snapshots of PDPCM displaying resting state and ''ballooning'' from effects of the Valsalva maneuver induced by crying. [2,4,8]. These examples highlight the potential difficulty in visualizing and diagnosing PDPCMs.…”

“…Patient presentation and treatment has varied widely in the literature [1][2][3][4][5][6][7][8][9]. More frequently-reported symptoms include stridor and feeding difficulties.…”

“…Additionally, a number of patients have presented with minimal or no symptoms. Awwad and Mortelliti reported four asymptomatic patients with a postcricoid vascular-appearing mass [2].…”

“…Of the 30 reported cases, eight underwent either CO 2 , Nd:Yag, or KTP laser ablation; three underwent open excision; two patients underwent tracheotomy; one had a gastrostomy tube placed; seven were treated with systemic steroids; one was treated with intralesionial steroids; and thirteen were successfully observed [1][2][3][4][5][6][7][8][9]. Several patients were treated with more than one modality.…”