A. Nordwig, A. Jassoy, J. Waldschmidt, W. Lässig (Halle-Dölau)  

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Thorax-Trachea  

congenital  

History: since the 10th week of life, worsening inspiratory stridor with changing appearance.

Findings: 12 week old boy in reduced general condition; tachypnea; partially opisthotonic posture; jugulary retractions; inspiratory stridor in rest; Pulmo: bilateral same ventilation, in- and expiratory rhonchi.  

The inspiratory stridor results from serious (>70%) constriction of the larynx in the glottic and/or subglottic area, or rather the extrathoracic part of the trachea. A subglottic hematoma (benign angiogenesis) as the cause should always be considered, if the course is an acute or slowly worsening one (inspiratory stridor) in the 1st - 3rd month of life and if the intensity is worsening. Because of infection, the patients are in severe danger because of accompanying mucosal swelling in the subglottic area.  

<- view MRI 1

MRI 1: T2-weigted transversal: subglottic hyperintense intratracheal soft tissue mass with a maximal length of ca. 10 mm craniocaudal. Also a 4 mm x 4 mm diameter. This causes the tracheal lumen to be about 10% of what it usually should be.




<- view MRI 2

MRI 2: T1-weighted after contrast media: strong homogenous contrast media absprbtion of the subglottic intratracheal soft tissue mass after dose of Gadolinium-DTPA




<- view Endoscopy 1

Endoscopy 1: Bronchoscopy: subglottic, starting dorsally, compressed tumor, which seriously restricted the tracheal lumen.


 

Imaging including endoscopy  

The most common cause of inspiratory in babies is the infantile larynx itself. Further differential diagnoses are the congenital and acquired structural subglottic stenosis, the paralysis of the recurrens nerve, and more uncommonly the stenosis of the ring cartilage, a larynx cyst, the subglottic flap, the larynx papillomatosis as well as an esophageal and vascular malformations.  

In spontaneous course, the intensity of the symptoms (inspiratory stridor to dyspnea) increases in the first months of life. Towards the end of the 1st year of life, the symptoms decrease and are completely gone after age 2 or 3. With this, the clinical image of growth and regression of the tumor can be followed.

Our patient underwent a subtotal coagulation with a ND:YAG-Laser by means of a tracheoscopy in the 14th week of life. The follow-up examination after 4 weeks showed a minimal residual finding in the left Paries memranaceus trachae, for which no treatment was needed. Clinically, the further course showed no abnormalities.  

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hemangioma, neovascularisation, larynx, subglottis, submucous hemangioma, subglottic trachea, child, childhood, pediatric radiology  

A Nordwig, A Jassoy, J Waldschmidt, W Lässig. Submucous hemangioma of the subglottic trachea. PedRad [serial online] vol 3, no. 9.
URL: www.PedRad.info/?search=20030904201557