Rafie A, Jolly K, Darr A, Thompson S
Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK.
Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
Ann R Coll Surg Engl. 2020 Sep;102(7):e152-e154. doi: 10.1308/rcsann.2020.0066. Epub 2020 Apr 20.
Laryngeal haemangiomas can commonly be seen in children, and first-line treatment is usually propranolol. However, in adults, cavernous haemangioma of the vocal cord(s) is an extremely rare condition - with this being the only published adult case presenting with acute respiratory distress - the mainstay of treatment is surgical excision under microlaryngoscopy. Presentation in adults can be unpredictable, but primarily consists of hoarseness which can be associated with, dyspnoea, dysphagia, and haemoptysis - and in one documented case stenosis of the aero-digestive tract led to death. Due to these airway difficulties, surgery can often prove challenging. In this study, we explore the unusual case of a previously well 71-year-old gentleman presenting to the Emergency Department, with worsening shortness of breath as his primary complaint. Uniquely, in this case, an awake fibre-optic intubation was undertaken to manage the difficult airway and a microlaryngoscopy was performed. A 20x10x15mm lesion was excised, which had characteristics in keeping with a cavernous haemangioma on microscopic examination.
喉血管瘤在儿童中较为常见，一线治疗通常是普萘洛尔。然而，在成人中，声带海绵状血管瘤是一种极为罕见的病症——这是唯一一例有急性呼吸窘迫表现的已发表成人病例——治疗的主要方法是在显微喉镜下进行手术切除。成人的症状表现可能难以预测，但主要症状为声音嘶哑，可能伴有呼吸困难、吞咽困难和咯血——在一个有记录的病例中，气道消化道狭窄导致了死亡。由于这些气道问题，手术往往具有挑战性。在本研究中，我们探讨了一名71岁既往健康的男性患者到急诊科就诊的不寻常病例，其主要症状是进行性加重的气短。在该病例中，独特之处在于采用了清醒纤维光导插管来处理困难气道，并进行了显微喉镜检查。切除了一个20×10×15毫米的病变，显微镜检查显示其特征符合海绵状血管瘤。
