Subglottic Hemangioma

A subglottic hemangioma is a large mass of blood vessels in the airway, typically below the vocal chords. They often grow very rapidly for six to 12 months and then start to slowly shrink.

Subglottic hemangioma is a serious condition because the mass can grow very large, obstructing the airway and affecting a child’s ability to breath. While many shrink, most will not shrink completely.

Subglottic hemangiomas have a strong association with skin hemangiomas, a common type of birthmark. Children diagnosed with a hemangioma in their airway often already have skin hemangiomas (sometimes called “strawberry marks”) on their skin, scalp, or back.

• Skin hemangiomas are benign and often go away on their own without treatment.
• Airway hemangiomas may require swift treatment because of their location in the airway and potential to be life threatening.

Read more about our comprehensive subglottic hemangioma treatment options at Boston Children’s.

Subglottic hemangioma is easily misdiagnosed because there are few signs and symptoms.

Children who develop hemangiomas in the airway often have them elsewhere on their skin (skin hemangioma), where they appear as a benign birthmark made up of a cluster of blood vessels.

Symptoms include:

• Persistent cough that may sound like croup
• Noisy breathing or stridor
• Troubled breathing

Children with a severe subglottic hemangioma may actually appear to be in respiratory distress. Our team at the Center for Airway Disorders is one the most experienced centers in the world diagnosing this rare disorder.

Hemangiomas are not hereditary (meaning they do not get passed down from parent to child). There is no known food, activity or medication during pregnancy that can cause a hemangioma to develop.

Research at Boston Children’s Vascular Biology Program has found that hemangiomas form from stem cells. This important discovery is helping our team investigate whether medications can stop their growth.

During a child’s appointment, a physician will first conduct a thorough medical exam and ask questions about to create a detailed medical history.

The physician may order an imaging test, such as an X-ray or if need be an MRI to see if there is a mass in his or her airway. However, at Boston Children’s we often recommend an endoscopy to get a more detailed, accurate picture of a child’s airway.

Expert subglottic hemangioma diagnosis at Boston Children’s

Because subglottic hemangioma is so rare with few symptoms, it is commonly misdiagnosed. If the disease progresses without treatment, it can severely affect a child’s ability to breathe.

At the Boston Children’s Center for Airway Disorders, our team includes some of the leading experts on this disorder. We are one of only a handful of programs with expertise treating and researching subglottic hemangioma, so we are able to quickly and accurately recognize the signs and symptoms and properly diagnose the condition.

We treat subglottic hemangioma at our Center for Airway Disorders, a world-renowned center known for our:

• Customized treatment plans for every child: This approach is important because while there are many treatment options for subglottic hemangioma, every child’s specific case is different.
• Multidisciplinary, team approach: We involve a team of specialists dedicated to your child’s care. In fact, at the Center for Airway Disorders, we work closely with more than a dozen departments and more than 40 specialists across Boston Children’s.
• Seamless care and support: We have a program coordinator who seamlessly manages every aspect of your child’s care and helps you understand what to expect at all stages.

A child’s specific treatment course will depend on a number of factors, including age and severity of symptoms. Our treatment options include:

• Propranolol (beta blockers): We often use propranolol as a first-line treatment. This drug is a beta blocker that constricts the capillaries in the hemangioma and slows its growth, causing it to shrink. We will monitor a child for 24-48 hours after first taking propranolol to watch for side effects.
• Steroids: Steroids may be used on their own for a short period of time to improve symptoms or may be used in conjunction with propranolol.
• Laser treatment: Small hemangiomas may be treated with a laser, a non-invasive procedure that shrinks the lesion but may require multiple treatments.
• Surgery: Large hemangiomas that threaten a child’s ability to breath may require surgical removal.

Families choose our expert team at our Center for Airway Disorders because we offer:

• Unmatched expertise: Many physicians will never encounter this rare airway disorder, but our expert team has treated or consulted on many cases over the past 20 years, giving us extensive experience treating it in children of all ages, even the most complex cases.
• Comprehensive care plans: Complex hemangioma patients often have other medical needs that require treatment, from heart complications to severe hemangiomas on their skin or liver. We carefully coordinate all aspects of a child’s medical needs with our partners throughout the hospital — from our Benderson Family Heart Center, ranked among the top in the U.S., to our Vascular Anomalies Center, considered the best of its kind in the world.
• Advanced treatment options: Even though subglottic hemangioma is rare, our team has developed a treatment plan involving the most advanced approaches, the latest medications (including propranolol), laser treatment, and, when necessary, minimally invasive surgery.
• Customized care: Our team knows that subglottic hemangioma may require customized treatment courses in every child, so we tailor our approach to a child’s needs.

We offer second opinions and consultations for patients living across the U.S. and around the world. If travel prohibits your child from receiving ongoing care on-site at our Boston hospital, our experts are available to evaluate your child and consult with a local physician to recommend the best treatment course.

If your child is an international patient, learn more about making an appointment through Boston Children’s Global Services.