Propranolol as first-line treatment of a severe subglottic haemangioma

Subglottic haemangioma (SGH) is a rare, benign tumour in children, which is potentially life-threatening because of airway obstruction. We report the case of a full-term 2-month-old infant girl admitted to our institution with stridor, dyspnoea and oxygen desaturation caused by a SGH and treated with propranolol. Neck-chest computed tomography (CT) revealed a contrast-enhancing, 10-mm, subglottic elliptic lesion, referable to SGH. Pre-treatment fibrobronchoscopy showed a sub-occlusive SGH closing more than 75% of the laryngotracheal airway. In agreement with our neonatologists and ear, nose and throat (ENT) specialists, we decided to begin oral propranolol therapy, which rapidly and dramatically improved respiratory symptoms. Fibrobronchoscopy six days after treatment confirmed a reduction of subglottic narrowing. Six months later the patient is doing well and without respiratory symptoms. To the best of our knowledge, this is the first reported case of the successful treatment with propranolol of an SGH obstructing more than 75% of the airway. The case is evidence of the effectiveness of oral propranolol as first-line treatment in the management of severely-obstructive paediatric SGH and the importance of CT and fibrobronchoscopy in the diagnosis; it also demonstrates the importance of multidisciplinary cooperation between thoracic surgeons, anaesthesiologists, neonatologists and ENT specialists in the treatment of these patients.