Elsevier

The Journal of Pediatrics

Volume 156, Issue 2, February 2010, Pages 335-338
The Journal of Pediatrics

Clinical and Laboratory Observation
Propranolol for the Treatment of a Life-Threatening Subglottic and Mediastinal Infantile Hemangioma

https://doi.org/10.1016/j.jpeds.2009.10.010Get rights and content

An infant with a subglottic hemangioma remained in respiratory distress after multiple treatments failed and was found to have an enlarging mediastinal infantile hemangioma compressing the trachea. Treatment with oral propranolol resulted in resolution of symptoms within 2 days and a 50% reduction in lesion size within 1 week.

Section snippets

Patient Presentation

A 5-week-old female infant had a 1-week history of progressive stridor and respiratory distress. No evidence of cutaneous hemangiomas was found with a physical exmaination. With direct laryngoscopy and bronchoscopy, a left-sided SH that was treated with endoscopic CO2 laser ablation was revealed. She was discharged home receiving oral dexamethasone, but soon further stridor and feeding intolerance developed.

She was then referred to Lucile Packard Children's Hospital. A second CO2 laser ablation

Discussion

Although IHs are benign tumors, SHs are potentially life-threatening because of obstruction of the airway during the proliferative phase. In a 1961 review, Ferguson reported a 50% mortality rate in affected infants.6 At that time, treatment was limited to tracheostomy. Today, treatment options include systemic and intralesional corticosteroids, laser ablation, open submucosal resection, and tracheostomy, with a reduction in mortality rate to 4%.7 Cases of intra-thoracic and mediastinal

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    Citation Excerpt :

    A subsequent randomized clinical trial showed that infants who received propranolol showed statistically significant reduction in the thickness of their hemangiomas as compared to a placebo group [13]. Propranolol has since become the first-line treatment for infantile hemangiomas, including those of the subglottis, producing excellent results in a number of case reports and retrospective series [4,5,14–30]. Side effects of propranolol are rare, but may include bradycardia, hypotension, and hypoglycemia [18].

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The authors declare no conflicts of interest.

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