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D'Ambrosio PD, Cardoso PFG, Silva PLD, Fernandes PMP, Minamoto H. Management of infantile subglottic hemangioma with T-tube placement and propranolol. J Bras Pneumol 2022; 48:e20210297. [PMID: 35293485 PMCID: PMC8964104 DOI: 10.36416/1806-3756/e20210297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Paula Duarte D'Ambrosio
- . Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
| | - Paulo F Guerreiro Cardoso
- . Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
| | - Priscila Loria da Silva
- . Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
| | - Paulo Manoel Pêgo Fernandes
- . Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
| | - Hélio Minamoto
- . Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
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Schwartz T, Faria J, Pawar S, Siegel D, Chun RH. Efficacy and rebound rates in propranolol-treated subglottic hemangioma: A literature review. Laryngoscope 2017; 127:2665-2672. [DOI: 10.1002/lary.26818] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/05/2017] [Accepted: 06/29/2017] [Indexed: 12/12/2022]
Affiliation(s)
| | - John Faria
- Department of Otolaryngology; University of Rochester; Rochester New York U.S.A
| | - Sachin Pawar
- Department of Otolaryngology and Communication Sciences; Medical College of Wisconsin; Milwaukee Wisconsin U.S.A
| | - Dawn Siegel
- Department of Dermatology; Medical College of Wisconsin; Milwaukee Wisconsin U.S.A
| | - Robert H. Chun
- Department of Dermatology; Medical College of Wisconsin; Milwaukee Wisconsin U.S.A
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Choi J, Im SA, Kim JY. Submucosal Hemangioma of the Trachea in an Infant: Diagnosis and Follow-Up with 3D-CT/Bronchoscopy. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e2346. [PMID: 26848371 PMCID: PMC4733287 DOI: 10.5812/ijp.2346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/10/2015] [Indexed: 11/16/2022]
Abstract
Introduction: Case Presentation: Conclusions:
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Affiliation(s)
- Jungwha Choi
- Department of Radiology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soo Ah Im
- Department of Radiology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jee Young Kim
- Department of Radiology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Corresponding author: Jee Young Kim, Department of Radiology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. Tel: +82-237792017, Fax: +82-27835288, E-mail:
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Abstract
Infantile hemangiomas (IHs) are the most common tumors of childhood. Unlike other tumors, they have the unique ability to involute after proliferation, often leading primary care providers to assume they will resolve without intervention or consequence. Unfortunately, a subset of IHs rapidly develop complications, resulting in pain, functional impairment, or permanent disfigurement. As a result, the primary clinician has the task of determining which lesions require early consultation with a specialist. Although several recent reviews have been published, this clinical report is the first based on input from individuals representing the many specialties involved in the treatment of IH. Its purpose is to update the pediatric community regarding recent discoveries in IH pathogenesis, treatment, and clinical associations and to provide a basis for clinical decision-making in the management of IH.
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Lou Y, Peng WJ, Cao Y, Cao DS, Xie J, Li HH. The effectiveness of propranolol in treating infantile haemangiomas: a meta-analysis including 35 studies. Br J Clin Pharmacol 2015; 78:44-57. [PMID: 24033819 DOI: 10.1111/bcp.12235] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 08/11/2013] [Indexed: 12/16/2022] Open
Abstract
AIMS Propranolol may have shown excellent results as a first line therapy in infantile haemangiomas (IHs) at all sites in the body, but this conclusion remains controversial. In an attempt to resolve this issue, we performed a meta-analysis. METHODS A search of the literature using PubMed, MEDLINE, Cochrane Library databases and China National Knowledge Infrastructure (CNKI) was performed to identify studies which estimated the efficacy of propranolol therapy in infants with haemangiomas all sites of the body. The pooled odds ratio (OR) along with the corresponding 95% confidence intervals (CI) were assessed using a fixed effects model. RESULTS Thirty-five studies involving 324 infantile haemangioma(IH) patients and 248 controls were retrieved and analyzed. The efficacy of propranolol was greater than other therapies in treating IHs (OR = 9.67, 95% CI 6.62, 14.12, P < 0.001). In a stratified analysis by sites of tumour, propranolol was a more effective therapy when compared with steroids (OR = 9.67, 95% CI 6.61, 14.15, P < 0.001), vincristine (OR = 9.00, 95% CI 2.15, 37.66, P = 0.003) and laser treatment (OR = 9.00, 95% CI 1.42, 57.12, P = 0.020) in treating cutaneous IHs (OR = 24.95, 95% CI 9.48, 65.64, P < 0.001), peri-ocular IHs (OR = 9.39, 95% CI 3.88, 22.71, P < 0.001), infantile airway haemangiomas (OR = 20.91, 95% CI 7.81, 55.96, P < 0.001) and infantile hepatic haemangiomas (OR = 9.89, 95% CI 1.20, 81.54, P = 0.033). CONCLUSION The current meta-analysis provided strong evidence for propranolol as a first line therapy for IHs.
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Affiliation(s)
- Yin Lou
- Department of Plastic Surgery, The Second Hospital of Anhui Medical University, Hefei
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Vivas-Colmenares GV, Bernabeu-Wittel J, Alonso-Arroyo V, Matute de Cardenas JA, Fernandez-Pineda I. Effectiveness of propranolol in the treatment of infantile hemangioma beyond the proliferation phase. Pediatr Dermatol 2015; 32:348-52. [PMID: 25721095 DOI: 10.1111/pde.12520] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
During the last 5 years, many studies have shown the efficacy of propranolol as first-line treatment for infantile hemangiomas (IHs), but not much has been written about the role of propranolol beyond the proliferation phase of IH (>1 year). Our aim was to assess propranolol efficacy and safety in the treatment of patients older than 1 year. A retrospective study of patients older than 1 year diagnosed with IH and treated in our vascular anomalies clinic between 2009 and 2013 was performed. Eighteen patients older than 1 year with a diagnosis of IH (15 girls, 3 boys) were identified. The mean age at the time of initiation of treatment was 25.7 months (range 13-72 mos). Single lesions were observed in 13 patients and multiple lesions in 5. Fifteen patients had focal lesions and three had segmental. The median duration of treatment with oral propranolol was 11.8 months (range 2-33 mos). Complete response was observed in 72.2% of the patients and partial response in 27.8%. Recurrence was observed in three patients 4.7 months after completion of therapy (range 0.3-8 mos). These patients required further therapy with propranolol for 6 more months. Bradycardia was documented in two patients and night terrors in one patient, which led to discontinuation of treatment. In our experience, propranolol may be useful in the treatment of IHs beyond the proliferation phase (>1 year old), but more studies are needed to support this observation.
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Affiliation(s)
| | - Jose Bernabeu-Wittel
- Department of Pediatric Dermatology, Virgen del Rocio Children's Hospital, Sevilla, Spain
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Abstract
Respiratory distress and stridor are common presenting symptoms for children in the emergency department. Most of these children will have common illnesses such as bronchiolitis or croup. Clinicians, however, must maintain a broad differential diagnosis and a healthy skepticism in the approach to each child's case so as not to miss uncommon or atypical presentations. We describe the case of a child with stridor in whom an airway hemangioma was ultimately diagnosed.
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Jacobson D, Nayan S, Macnay R, Maclean J. Intra-thyroidal hemangioma--a rare congenital anomaly: case presentation and literature review. Int J Pediatr Otorhinolaryngol 2014; 78:1779-83. [PMID: 25130945 DOI: 10.1016/j.ijporl.2014.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/09/2014] [Indexed: 10/25/2022]
Abstract
Infantile hemangiomas (IH) present and evolve in a predictable way. In certain cases, however, they can be of clinical significance. IHs in the airway can cause significant respiratory distress. We present the first reported case of an intrathyroidal hemangioma to cause significant respiratory distress, which was successfully treated with propranolol and dexamethasone. A review of the literature was also performed.
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Affiliation(s)
- Dustin Jacobson
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main St. W., Hamilton, ON, Canada L8N 3Z5
| | - Smriti Nayan
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McMaster University, 1200 Main St. W., Hamilton, ON, Canada L8N 3Z5.
| | - Ramsay Macnay
- Department of Pediatrics, McMaster University, 1200 Main St. W., Hamilton, ON, Canada L8N 3Z5
| | - Jonathan Maclean
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McMaster University, 1200 Main St. W., Hamilton, ON, Canada L8N 3Z5
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Joshi V, Malik V, Mirza O, Kumar BN. Fifteen-minute consultation: structured approach to management of a child with recurrent croup. Arch Dis Child Educ Pract Ed 2014; 99:90-3. [PMID: 24231112 DOI: 10.1136/archdischild-2013-303846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Recurrent croup is a distinct clinical entity from viral croup. It is not a specific diagnosis and its presence should alert the clinician to explore the underlying cause. We discuss an evidence-based structured approach to management of a child with recurrent croup.
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Affiliation(s)
- Vineeta Joshi
- Department of Paediatrics, Royal Albert Edward Infirmary, Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, Lancashire, UK
| | - Vikas Malik
- Department of Otolaryngology Otolaryngology and Head and Neck Surgery, Royal Albert Edward Infirmary, Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, Lancashire, UK
| | - Omar Mirza
- Department of Otolaryngology Otolaryngology and Head and Neck Surgery, Royal Albert Edward Infirmary, Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, Lancashire, UK
| | - B Nirmal Kumar
- Department of Otolaryngology Otolaryngology and Head and Neck Surgery, Royal Albert Edward Infirmary, Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, Lancashire, UK
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Abstract
Infantile hemangioma is the most common soft tissue tumor of childhood. Despite its frequency, it has only been in the last decade that these lesions have been better characterized and become the subject of significant clinical and translational research. Although most infantile hemangiomas are uncomplicated and do not require intervention, they can be a significant source of parental distress, cosmetic disfigurement, and morbidity. The wide spectrum of disease in the morphology of these lesions and in their behavior has made it difficult to predict the need for treatment and has made it challenging to establish a standardized approach to management.
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Affiliation(s)
- Kristen E Holland
- Department of Dermatology, Medical College of Wisconsin, 9000 West Wisconsin Avenue, Suite B260, Milwaukee, WI 53226, USA.
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Theologie-Lygidakis N, Schoinohoriti OK, Tzerbos F, Iatrou I. Surgical management of head and neck vascular anomalies in children: a retrospective analysis of 42 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 117:e22-31. [PMID: 22921448 DOI: 10.1016/j.oooo.2012.02.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 02/13/2012] [Accepted: 02/24/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This article aimed to present a series of surgically treated head and neck vascular anomalies during a 12-year period, highlighting the epidemiology, diagnostic approach, indications for surgery, and final clinical outcome. STUDY DESIGN The medical records of all patients with head and neck vascular anomalies, surgically treated at our department from 1998 to 2010, were reviewed retrospectively. RESULTS A total of 42 patients with 46 vascular anomalies were identified. Patients' diagnoses included vascular tumors, hemangiomas mainly (18 cases), and various vascular malformations (26 cases). All patients were submitted to surgical treatment (excision-resection) to resolve main clinical symptoms (ulceration, bleeding, impaired mastication and feeding, airway obstruction) and/or esthetic issues. Recurrence was noted in 3 patients. CONCLUSION Accurate differential diagnosis based on history, physical examination, and imaging, is the key to optimal treatment. Surgical intervention is warranted for small to moderately extended lesions to avoid complications and/or esthetic concerns and psychosocial distress.
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Affiliation(s)
| | | | - Fotios Tzerbos
- Assistant Professor, Oral and Maxillofacial Surgery, Dental School, University of Athens, Athens, Greece
| | - Ioannis Iatrou
- Professor, Oral and Maxillofacial Surgery, Dental School, University of Athens, Athens, Greece
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Raol N, Metry D, Edmonds J, Chandy B, Sulek M, Larrier D. Propranolol for the treatment of subglottic hemangiomas. Int J Pediatr Otorhinolaryngol 2011; 75:1510-4. [PMID: 21944056 DOI: 10.1016/j.ijporl.2011.08.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 08/23/2011] [Accepted: 08/23/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Infantile subglottic hemangiomas are rare causes of airway obstruction. They begin to proliferate at 1-2 months of age and can cause biphasic stridor with or without respiratory distress. Diagnosis requires direct visualization by direct laryngoscopy and bronchoscopy. Various therapeutic options have been utilized for treatment, including tracheotomy, open surgical excision, laser ablation, intralesional steroid injection, systemic steroids, and now oral propranolol. METHODS We present a retrospective chart review of infantile subglottic hemangiomas over a 5-year span (January 2005-2010) at a tertiary care pediatric hospital. IRB approval was obtained, and charts were reviewed to find patients with subglottic hemangiomas, including patient characteristics, presentation, workup, medical and surgical management, and outcomes. A case presentation demonstrates diagnostic, management, and treatment strategies and dilemmas encountered. RESULTS Nine patients were found to have infantile subglottic hemangiomas. Six of nine patients were treated with laser excision, with five of the six having localized subglottic hemangiomas. In 2009, three of four patients were initiated on propranolol as first-line treatment; the fourth had comorbidities which precluded this. Of the three, two showed improvement, while a third, who also had bearded hemangioma, required tracheotomy. DISCUSSION Infantile subglottic hemangiomas are rare but essential in the differential diagnosis of biphasic stridor. Although propranolol has been effective in treating cutaneous and airway hemangiomas, our experience suggests that this is not consistent for subglottic hemangiomas. In an area where airway compromise can be lethal, we must extend caution and monitor these patients closely as they may require adjuvant therapy.
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Affiliation(s)
- Nikhila Raol
- Department of Otolaryngology, Texas Children's Hospital, Houston, TX, United States.
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Solución del caso 29. Hemangioma subglótico congénito. RADIOLOGIA 2011; 53:275-7. [DOI: 10.1016/j.rx.2010.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Accepted: 02/15/2010] [Indexed: 11/22/2022]
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Longstreet B, Bhama PK, Inglis AF, Saltzman B, Perkins JA. Improved airway visualization during direct laryngoscopy using self-retaining laryngeal retractors: a quantitative study. Otolaryngol Head Neck Surg 2011; 145:270-5. [PMID: 21521892 DOI: 10.1177/0194599811405429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To measure the degree to which the Lindholm laryngeal distending forceps improve visualization during direct laryngoscopy in selected pediatric patients. STUDY DESIGN Case series with chart review. SETTING Pediatric hospital. SUBJECTS AND METHODS Subjects included children undergoing direct laryngoscopy using the Lindholm laryngeal distending forceps. Intraoperative endoscopic photos with and without false cord retraction via the Lindholm laryngeal distending forceps were obtained from the Seattle Children's Hospital airway endoscopy photo library. Analysis was performed using imaging software. Comparisons of visible vocal cord and glottic opening areas as well as anterior commissure angles with and without the Lindholm laryngeal distending forceps were performed with a paired and unpaired Student t test. RESULTS The use of the Lindholm laryngeal distending forceps increased the glottic opening by a mean of 359% (95% confidence interval [CI], 255%-463%) and increased visualized true vocal cord area by 337% (197%-477%). Angle at the anterior commissure increased from a mean of 24.9° to a mean of 71.5°, resulting in a net mean angle increase of 46.6° (95% CI, 40.2°-52.9°). All measured changes were statistically significant with P values <.01. CONCLUSIONS When placed at the level of the false vocal folds, Lindholm laryngeal distending forceps will, at least in certain cases, greatly increase the visible area of the superior surface of the vocal folds, the anterior commissure, and, by increasing the glottic opening, the subglottic region. This improved visualization may enhance the surgeon's ability to diagnose and treat pathologies in these anatomic regions during direct laryngoscopy.
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Affiliation(s)
- Beck Longstreet
- University of Washington School of Medicine, Seattle, Washington, USA
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Peridis S, Pilgrim G, Athanasopoulos I, Parpounas K. A meta-analysis on the effectiveness of propranolol for the treatment of infantile airway haemangiomas. Int J Pediatr Otorhinolaryngol 2011; 75:455-60. [PMID: 21333364 DOI: 10.1016/j.ijporl.2011.01.028] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 01/23/2011] [Accepted: 01/25/2011] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To study the effectiveness of propranolol in infantile airway haemangiomas and compare the effectiveness of propranolol vs. different therapies. METHODS A literature search of Ovid, Embase, the Cochrane database, Google™ Scholar, and Medline using PubMed as the search engine was performed to identify studies that analysed the effect of propranolol treatment in children with airway haemangiomas. Random-effect meta-analytical techniques were conducted for the outcome measures. RESULTS Thirteen studies, comprising 36 patients were included in the analysis. Propranolol was found to be an effective intervention for the resolution of infantile airway haemangiomas (P<0.00001). Meta-analysis of effectiveness of propranolol vs. steroids, CO(2) laser, or vincristine showed that propranolol is the most effective treatment. CONCLUSIONS This meta-analysis demonstrated that propranolol should be recommended as a first-line treatment in infantile airway haemangiomas. However, because of the possible side effects of propranolol, current infantile haemangioma treatment centres recommend a full cardiovascular and respiratory review be performed prior to initiation of therapy.
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Affiliation(s)
- Stamatios Peridis
- Department of Otolaryngology Head and Neck Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
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Parhizkar N, Manning SC, Inglis AF, Finn LS, Chen EY, Perkins JA. How airway venous malformations differ from airway infantile hemangiomas. ACTA ACUST UNITED AC 2011; 137:352-7. [PMID: 21242531 DOI: 10.1001/archoto.2010.243] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare airway infantile hemangiomas (IHs) and venous malformations (VMs) clinically, radiographically, endoscopically, and histologically. DESIGN Retrospective cohort study. SETTING Tertiary care pediatric hospital. PATIENTS The study included patients seen in the Vascular Anomaly Clinic, Seattle Children's Hospital, Seattle, Washington, between 2001 and 2008. METHODS All patients with airway vascular anomalies were identified by searching the Vascular Anomaly Quality Improvement Database and hospital discharge data. The data, which were analyzed with descriptive statistics and the Fisher exact test, included presenting age, sex, presenting signs, lesion site, and radiographic, endoscopic, and histologic findings.. RESULTS Seventeen patients with airway lesions were identified, 6 with VMs and 11 with IHs. Patients with VMs presented at a mean (SD) age of 11.3 (13.7) months (age range, 3-39 months), while those with IHs presented at 3 (1.8) months of age (age range, 1-6 months) (P = .03). The patients with IHs were predominantly female (9 of 11 [81%]), while no sex difference was noted among the patients with VMs (3 of 6 [50%]). All patients with IHs presented with stridor and cutaneous lesions, whereas patients with VMs more often presented with hemoptysis or dysphagia (P = .001). Computed tomographic angiograms demonstrated enhancing endolaryngeal lesions in all IHs, while VMs enhanced poorly. Endoscopically, IHs were transglottic, while VMs were postcricoid or epiglottic (P < .001). Histologically, immunostained lesions showed submucosal lobules of capillaries lined by GLUT-1 (glucose transporter isoform 1)-positive endothelium in IHs, whereas VMs consisted of loosely organized venous channels that lacked GLUT-1 staining. CONCLUSION Patients with airway IHs and VMs differ in presenting age and signs, sex, airway lesion location, enhancement on computed tomographic angiograms, and histologic appearance.
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Affiliation(s)
- Nooshin Parhizkar
- DO, Division of Pediatric Otolaryngology, Seattle Children's Hospital, 4800 Sand Point Way NE, Mail Stop W-7729, Seattle, WA 98105-0371, USA
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Cushing SL, Boucek RJ, Manning SC, Sidbury R, Perkins JA. Initial Experience With a Multidisciplinary Strategy for Initiation of Propranolol Therapy for Infantile Hemangiomas. Otolaryngol Head Neck Surg 2010; 144:78-84. [DOI: 10.1177/0194599810390445] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives. To outline a safe, standardized protocol for outpatient initiation of propranolol therapy for infantile hemangiomas. Study Design. Retrospective review. Setting. Academic tertiary care pediatric hospital. Subjects and Methods. Forty-nine infantile hemangioma patients were offered propranolol therapy and included in the study. Any patients requiring hospital admission were excluded. Screening consisted of cardiology evaluation, including electrocardiography and, when indicated, echocardiography. Target initiation dose was 2 to 3 mg/kg/d divided into 3 doses. Blood pressure and heart rate were initially monitored at baseline and 1 and 2 hours in clinic following initial dosing. A 3-hour time point was later added. Families received standardized instructions regarding home heart rate monitoring, side effects, and fasting. Results. Outpatient propranolol therapy was safely initiated in 39 of 44 patients (89%). Five patients required brief admission: 1 with clinical signs/symptoms of heart failure, 3 having airway involvement, and 1 for social reasons. Propranolol administration transiently reduced blood pressure; the maximal decrease occurred at 2 hours, prompting addition of a 3-hour time point to ensure recovery. No patients exhibited symptomatic hypotension, bradycardia, or heart failure. Conclusions. In most children with infantile hemangiomas, propranolol therapy can be safely initiated as an outpatient. Careful cardiovascular evaluation by an experienced clinician is essential for pretreatment evaluation, inpatient admission (when necessary), blood pressure and heart rate monitoring following initial dosing, and parent education. This standardized multidisciplinary outpatient initiation plan reduces the cost of initiating therapy compared with inpatient strategies while still providing appropriate monitoring for potential treatment complications. Further evaluation of propranolol therapy efficacy at the current dosing and duration of treatment continues.
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Affiliation(s)
- Sharon L. Cushing
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, Washington, USA
- Department of Otolaryngology, Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Robert J. Boucek
- Division of Cardiology, Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Scott C. Manning
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, Washington, USA
- Department of Otolaryngology, Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Robert Sidbury
- Division of Dermatology, Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Jonathan A. Perkins
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, Washington, USA
- Department of Otolaryngology, Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:577-81. [DOI: 10.1097/moo.0b013e328340ea77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Infantile hemangiomas (IHs) are the most common soft tissue tumors of childhood. The wide spectrum of disease has made it difficult to predict need for treatment and has made it challenging to establish a standardized approach to management. This article provides the reader with an up-to-date discussion of IH, identifying features of this condition which predict need for treatment as well as associated complications and reviewing management.
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Affiliation(s)
- Kristen E Holland
- Department of Dermatology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Santos S, Torrelo A, Tamariz-Martel A, Domínguez MJ. Observaciones clínicas sobre el uso de propranolol en hemangiomas de vía aérea infantil. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61:365-70. [DOI: 10.1016/j.otorri.2010.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 01/23/2010] [Accepted: 01/25/2010] [Indexed: 10/19/2022]
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Truong MT, Perkins JA, Messner AH, Chang KW. Propranolol for the treatment of airway hemangiomas: a case series and treatment algorithm. Int J Pediatr Otorhinolaryngol 2010; 74:1043-8. [PMID: 20674045 DOI: 10.1016/j.ijporl.2010.06.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 06/01/2010] [Indexed: 01/12/2023]
Abstract
OBJECTIVES (1) To present six patients with symptomatic airway hemangiomas treated with oral propranolol. (2) To review the diagnostic and treatment options for airway hemangiomas and propose a new management protocol. STUDY DESIGN Retrospective review. SETTING Tertiary care children's hospital. SUBJECTS AND METHODS Pediatric patients diagnosed with obstructive airway hemangiomas treated with oral propranolol. Patients were followed for symptomatic improvement and relief of airway obstruction on imaging or laryngoscopy. RESULTS Seven patients presenting with airway obstruction were treated with propranolol. One patient had a focal hemangioma confined to the subglottis. Four patients had airway hemangiomas that extended beyond the confines of the larynx and trachea. A sixth patient had a bulky supraglottic hemangioma. A seventh patient with an extensive maxillofacial lesion failed propranolol therapy and was found to have a pyogenic granuloma on final pathology after excision. Six patients had failed standard medical therapy and/or surgical interventions and were treated successfully with oral propranolol with improvements in airway symptoms and oral intake, requiring no further surgical intervention. Treatment was initiated as early as 1.5 months of age, and as late as 22 months. No adverse side effects of propranolol were noted. CONCLUSIONS Oral propranolol was successfully used to treat airway hemangiomas, resulting in rapid airway stabilization, obviating the need for operative intervention, and reducing the duration of systemic corticosteroid therapy while causing no obvious adverse effects. These outstanding results enable the possibility of use of a standardized diagnostic and treatment algorithm for airway hemangiomas that incorporates systemic propranolol.
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Affiliation(s)
- Mai Thy Truong
- Kaiser Permanente Hospital, Department of Otolaryngology, 710 Lawrence Expressway, Dept 296, Santa Clara, CA 95051, USA.
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Initial experience using propranolol as the sole treatment for infantile airway hemangiomas. Int J Pediatr Otorhinolaryngol 2010; 74:323-5. [PMID: 20071038 DOI: 10.1016/j.ijporl.2009.12.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 12/14/2009] [Accepted: 12/15/2009] [Indexed: 12/20/2022]
Abstract
The objective of this study is to describe the initial use of propranolol as the sole treatment for focal infantile airway hemangiomas, and to report on available literature describing the use of propranolol for airway lesions. This retrospective case series was carried out at a tertiary pediatric medical center. We obtained the following results: two children demonstrated significant response to oral propranolol therapy and avoided not only invasive surgical procedures, but also long-term administration of oral corticosteroids. This is the first report of treating infantile airway hemangiomas with only propranolol without additional surgical intervention or corticosteroid use. Review of literature reveals initial case series with similar, successful results using propranolol as an adjuvant treatment along with other medications and surgical interventions. We conclude that the initial use of propranolol as the sole treatment for infantile airway hemangioma is promising. Literature review reveals that propranolol as the sole treatment for most head and neck hemangiomas shows significant promise based on early case reports. Further studies are needed to determine the long-term effectiveness, dosing strategies, and side effect profile of propranolol treatment for hemangiomas.
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Santos S, Torrelo A, Tamariz-Martel A, Domínguez MJ. Clinical observations on propranolol use for paediatric airway hemangiomas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010. [DOI: 10.1016/s2173-5735(10)70066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Perkins JA, Chen EY, Hoffer FA, Manning SC. Proposal for Staging Airway Hemangiomas. Otolaryngol Head Neck Surg 2009; 141:516-521. [DOI: 10.1016/j.otohns.2009.06.751] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 06/30/2009] [Accepted: 06/30/2009] [Indexed: 12/01/2022]
Abstract
OBJECTIVE: To describe a method of airway infantile hemangioma staging using standardized assessment of airway narrowing, and hemangioma location and volume, as determined with endoscopy and CT angiography. STUDY DESIGN: Case series with chart review. SETTING: Tertiary pediatric hospital, 2003-2008. SUBJECTS AND METHODS: Subjects included airway hemangioma patients evaluated at a tertiary pediatric hospital. Data collected were age at first symptoms, diagnostic evaluation, percent airway compromise, and estimated hemangioma volume. Data were analyzed with descriptive and Fisher exact statistics. RESULTS: Twelve patients were identified and seven had complete data sets. Mean age at first symptoms was 1.9 months (SD 1.09 months, range 0.5-4 months). Evaluation consisted of nasopharyngoscopy, microlaryngoscopy, CT angiography, and/or MRI. Mean laryngeal airway narrowing was estimated at 63.75 percent (SD 19.0%, range 40%-90%). Total hemangioma volume was less in patients with isolated (focal) endolaryngeal hemangiomas compared with airway hemangiomas associated with extralaryngeal (segmental) hemangiomas. Airway hemangioma stages were stage one (5 of 12; 41.6%), stage two (6 of 12; 50.0%), and stage three (1 of 12; 8.3%). CONCLUSION: This method of airway hemangioma staging may be applicable to treatment planning and used to measure treatment outcomes.
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Affiliation(s)
- Jonathan A. Perkins
- the Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA
- the Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
| | - Eunice Y. Chen
- the Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA
- the Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
| | - Fredric A. Hoffer
- the Department of Pediatric Radiology, Seattle Children's Hospital, Seattle, WA
| | - Scott C. Manning
- the Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA
- the Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
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