Subglottic and mediastinal hemangioma in a child: treatment with propranolol.

To the Editor: A 6-month-old girl with upper airway obstruction was evaluated in the emergency room. The patient had been born prematurely (at gestational week 34). Prior to the emergency room visit, she had been treated for gastroesophageal reflux and recurrent respiratory infection. Physical examination revealed laryngeal stridor. All laboratory test results were normal. A CT scan of the chest, larynx, and trachea showed a heterogeneous, highly vascularized mass in the left hemithorax (Figure 1). However, there was no cardiac malformation. Rigid bronchoscopy performed under general anesthesia revealed a large pulsatile mass that obstructed approximately 80% of the larynx and trachea (Figure 2a; Video 1*). On the basis of the radiological and endoscopic findings, a diagnosis of hemangioma was made. Because of the risk of bleeding, we decided not to perform a biopsy. Corticosteroid therapy was initiated (betamethasone, 0.5 mg/kg per day). After two weeks of treatment with the corticosteroid, the patient showed no clinical improvement. The corticosteroid therapy was discontinued, and treatment was started with propranolol (1 mg/ kg per day). To avoid potential complications, cardiac function and blood glucose levels were monitored. After 5 days of treatment, a clinical response was observed, and the stridor lessened. The dose of propranolol was gradually increased to 2 mg/kg per day. After 3 months of treatment, the patient again underwent rigid bronchoscopy (Figure 2b; Video 2†). There was endoscopic improvement, the lesion showing a reduction in size and tracheal lumen obstruction being less than 20%. We found no granulation tissue