Propranolol as first-line treatment of a severe subglottic hemangioma

Subglottic hemangioma (SGH) is a rare benign tumour of childhood that can be potentially lifethreatening because of airway obstruction. We report the case of a term 2-month-old infant girl admitted to our Institution with stridor, dyspnea and oxygen desaturation caused by a SGH and treated with propranolol. Neck-chest computed tomography (CT) revealed a contrast-enhancing 10 mm subglottic elliptic lesion, referable to SGH. Pre-treatment fiberbronchoscopy showed a sub-occlusive SGH, closing more than 75% of the laryngotracheal airway. In agreement with our neonatologists and ear-nose-throat (ENT) specialists, we decided to begin oral propranolol therapy, that rapidly and dramatically improved respiratory symptoms. Fiberbronchoscopy 6 days after treatment confirmed the reduction of the degree of subglottic narrowing. Six months later the patient is doing well without respiratory symptoms. To the best of our knowledge, this is the first reported case of SGH obstructing more than 75% of the airway, successfully treated with propranolol. The case evidences the effectiveness of oral propranolol as first-line treatment in the management of severely obstructive paediatric SGH and the importance of CT and fiberbronchoscopy in the diagnosis; it also proves the importance of multidisciplinary cooperation between thoracic surgeons, anaesthesiologists, neonatologists and ENT specialists for the treatment of these patients.