Postcricoid vascular abnormalities: hemangiomas, venous malformations, or anatomic variant

Int J Pediatr Otorhinolaryngol. 2012 Jun;76(6):805-8. doi: 10.1016/j.ijporl.2012.02.047. Epub 2012 Mar 16.

Abstract

Objective: Ten children with pressure-dependent postcricoid masses (PDPCM) previously referred to in the literature as hemangiomas or vascular malformations are presented. We propose these lesions represent an anatomic variant. We review previously reported cases, and report the presentation, diagnosis, and management of the patients in our series, the largest series to date.

Methods: Ten patients, aged five weeks to nine months, were diagnosed, and treated or observed. Of the patients undergoing intervention, one was treated with a gastrostomy tube, fundoplication, and Propranolol therapy; and the other with CHARGE association underwent a tracheotomy.

Results: No PDPCMs demonstrated significant interval change in size or appearance, and eight of ten patients did well with observation.

Conclusion: Based on current information, the majority of PDPCMs likely represent an anatomic variant rather than a hemangioma or vascular malformation. Diagnosis is most readily made with awake flexible fiberoptic laryngoscopy. Because the incidence of synchronous airway pathology is high, direct laryngoscopy and bronchoscopy without routine biopsy is recommended for symptomatic patients. Imaging should be individualized and may be helpful for ambiguous cases. Although numerous treatment modalities have been advocated based on the presumptive diagnosis of a hemangioma, treatment of PDPCMs is not necessary in the majority of cases, as most patients may be safely observed.

Publication types

  • Comparative Study

MeSH terms

  • Airway Obstruction / diagnosis
  • Airway Obstruction / etiology
  • Arteriovenous Malformations / diagnosis*
  • Arteriovenous Malformations / therapy
  • Biopsy, Needle
  • Cohort Studies
  • Cricoid Cartilage / abnormalities*
  • Cricoid Cartilage / blood supply*
  • Cricoid Cartilage / pathology
  • Diagnosis, Differential
  • Female
  • Follow-Up Studies
  • Hemangioma / diagnosis*
  • Hemangioma / therapy
  • Humans
  • Immunohistochemistry
  • Infant
  • Infant, Newborn
  • Laryngeal Diseases / diagnosis
  • Laryngeal Diseases / therapy
  • Laryngeal Neoplasms / diagnosis*
  • Laryngeal Neoplasms / therapy
  • Laryngoscopy / methods
  • Male
  • Monitoring, Physiologic / methods
  • Retrospective Studies
  • Risk Assessment
  • Treatment Outcome