# Second Scope, New Findings: Pediatric Stridor Is Not Always Due to Croup or Laryngomalacia: A Case Report

## TL;DR

A rare infant condition causing stridor and breathing issues was misdiagnosed initially but later identified as subglottic hemangioma.

## Contribution

Highlights subglottic hemangioma as a rare but critical cause of respiratory distress in infants, often misdiagnosed as croup or laryngomalacia.

## Key findings

- Subglottic hemangioma can present with stridor and respiratory distress, mimicking more common conditions.
- Early diagnosis and treatment with propranolol can prevent life-threatening airway obstruction.
- Pediatric patients with unresponsive stridor should be evaluated for subglottic hemangioma.

## Abstract

Infantile subglottic hemangioma is a rare and serious condition characterized by stridor, respiratory distress, and a barking cough. This condition poses a significant risk as it can lead to life-threatening airway obstruction.

We present a five-week-old patient who was diagnosed in the emergency department (ED) with moderate laryngomalacia via laryngoscopy by otolaryngology and discharged; he returned to the ED the next day with worsening symptoms of recurrent stridor, difficulty feeding, and worsening respiratory distress. A second laryngoscopic exam performed on the return ED visit revealed a subglottic mass that was later identified as a left-sided subglottic hemangioma via bronchoscopy and magnetic resonance imaging. The patient was treated with propranolol and discharged from the inpatient unit with dermatology and otolaryngology follow-up.

Infantile subglottic hemangioma is a rare but serious cause of respiratory distress in infants, posing a risk of airway obstruction. This diagnosis should be considered in the ED, particularly for patients under two years of age, who present with recurrent stridor and respiratory distress and do not respond to standard treatments for croup.