A Case of Rapidly Progressive Subglottic Hemangioma in an Infant: Early Propranolol Therapy Prevented Tracheostomy

TL;DR

A preterm infant with a severe airway tumor was successfully treated with early propranolol therapy, avoiding the need for tracheostomy.

Contribution

This case demonstrates that early propranolol treatment can prevent invasive surgery in infants with rapidly progressive subglottic hemangioma.

Findings

Oral propranolol led to rapid regression of the subglottic hemangioma within 10 days.

The infant was successfully extubated without requiring a tracheostomy.

No recurrence was observed at 24 months of follow-up.

Abstract

Subglottic hemangioma is a rare but potentially life-threatening cause of neonatal airway obstruction. We report the case of a preterm infant who developed rapidly progressive biphasic stridor at 36 days of life. Flexible laryngoscopy revealed a subglottic mass, and contrast-enhanced computed tomography demonstrated a well-circumscribed, enhancing lesion causing >70% airway narrowing. Following careful airway planning, the patient was intubated safely and treated with oral propranolol, resulting in marked regression within 10 days and successful extubation without tracheostomy. The infant remained symptom-free, with no recurrence at 24 months. This case highlights the importance of early recognition of biphasic stridor, prompt laryngoscopic evaluation, and timely propranolol initiation, which may avert invasive surgical interventions.

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