Pediatric Supraglottic Hemangioma Causing Airway Obstruction: A Case Report

Supraglottic hemangiomas are rare vascular malformations of the larynx, particularly in children. They may cause life-threatening airway obstruction if not diagnosed and managed promptly. We report a case of a large supraglottic hemangioma in a young child, presenting with progressive respiratory distress and stridor, successfully managed with endoscopic excision.

Keywords: Supraglottic hemangioma, pediatric airway, vascular malformation, laryngeal obstruction, endoscopic excision

Introduction

Infantile hemangiomas are the most common benign vascular tumors of infancy, typically involving the skin and subcutaneous tissues. Laryngeal involvement is uncommon, with supraglottic localization accounting for a small subset of airway lesions. The reported incidence of airway hemangiomas is approximately 1 in 100,000 live births, with the subglottic region being the most frequently affected site. Early diagnosis is critical because rapid proliferation during infancy can result in severe airway obstruction and respiratory compromise.

Case Presentation

A 2-year-old male presented with a 3-month history of progressive inspiratory stridor, noisy breathing, and intermittent choking episodes. There was no history of cyanosis, hoarseness, or previous airway instrumentation. On examination, the child exhibited mild respiratory distress with inspiratory stridor and suprasternal retraction.

Flexible fiberoptic laryngoscopy revealed a large, smooth, bluish, compressible mass arising from the epiglottis and aryepiglottic folds, partially occluding the supraglottic airway. Contrast-enhanced CT of the neck showed a well-circumscribed, intensely enhancing lesion measuring 2.5 × 2.0 cm in the supraglottic region, suggestive of a vascular tumor.

The child underwent direct laryngoscopy and endoscopic excision under general anesthesia. Intraoperatively, a large hemangiomatous mass involving the epiglottis and aryepiglottic folds was identified. The lesion was excised using cold instruments and laser cautery with minimal bleeding. The airway was secured throughout the procedure.

Histopathology confirmed a capillary hemangioma composed of closely packed capillary-sized vessels lined by flattened endothelium within a fibrous stroma. The postoperative recovery was uneventful, and the child was extubated on the second postoperative day. Follow-up laryngoscopy at 6 months demonstrated complete healing and no evidence of recurrence.

Discussion

Laryngeal hemangiomas are rare and most often present within the first year of life. The supraglottic variant, though less common than subglottic hemangioma, can cause significant airway obstruction. The classic clinical triad includes stridor, feeding difficulties, and voice changes.

Diagnosis is primarily established through flexible laryngoscopy and imaging—typically CT or MRI—to delineate the extent and vascular nature of the lesion. MRI is superior for soft-tissue characterization, but CT with contrast may be more accessible in resource-limited settings.

Management depends on the size, site, and severity of symptoms. Small, asymptomatic lesions may be observed, while symptomatic or rapidly enlarging lesions require intervention. Systemic propranolol has become the first-line therapy for infantile hemangiomas, inducing regression via vasoconstriction, decreased angiogenic signaling, and apoptosis of endothelial cells. However, in cases with large, obstructive, or non-responsive lesions—as in our case—surgical excision or laser ablation remains the treatment of choice.

Advances in endoscopic techniques, including the use of CO₂ or KTP lasers, have significantly improved outcomes by allowing precise removal with minimal bleeding and tissue damage. Long-term follow-up is essential to monitor for recurrence or residual airway compromise.

Conclusion

Supraglottic hemangiomas, though rare, should be considered in the differential diagnosis of persistent stridor in children. Early airway assessment and individualized treatment planning are essential. Endoscopic excision provides an effective and safe therapeutic option for large, symptomatic lesions, ensuring complete relief of obstruction and favorable long-term outcomes.

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