This paper reviews the diagnosis and management of infantile haemagiomas (IH) affecting the airway. Approximately half of infants with this condition would also have cutaneous haemagiomas which are usually in the beard distribution. IH could affect any parts of the airway but generally patients would present with symptoms if the subglottis is involved. The symptoms are usually biphasic stridor and barking cough. IH should be suspected in infants with recurrent or persistent croup. They would usually present within the first six months of life when the haemagioma undergoes the proliferative phase but rarely at birth. IH would subsequently undergo regression from one year of age. The diagnosis could be confirmed with airway endoscopy and subsequently CT angiogram to assess extent of disease. Management of IH could be broadly divided into conservative, medical or surgical. Conservative treatment of IH is advocated for children who are minimally symptomatic as IH eventually regress. Pharmacotherapy with propanolol has become the mainstay for IH treatment in recent years. However, there are reports of lack of response to treatment and recurrence. The treatment dose varies in the literature but in most series, the treatment protocol were 1mg/kg/d to 2mg/kg/d divided into 2 to 3 times a day and increased over several days to a week to 2mg/kg/d or 3mg/kg/d. Prior to treatment an assessment of the child’s cardiac status is needed including electrocardiogram, blood pressure and heart rate. Surgical intervention is indicated if the airway is at significant risk or IH is refractory to medical treatment. Options include intralesional steroid injection or partial ablation or excision of the lesion. The author described both endoscopic and open excision techniques. Following a surgical procedure, the patient should remain on medical therapy to avoid recurrence. In conclusion, this article summarises up to date investigations and treatment of IHs.
Management of infantile haemagiomas of the airway
Reviewed by Wai Sum Cho
Management of infantile haemagiomas of the airway.
