Paediatric Otolaryngology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Stem Cell and Regenerative medicine, UCL Great Ormond Street Hospital Institue of Child Health, London, UK.
BMJ Case Rep. 2021 May 19;14(5):e241074. doi: 10.1136/bcr-2020-241074.
Subglottic haemangioma presents as progressive obstruction in the neonatal and infantile airway, with a soft lesion seen during endoscopy. Diagnosis is based on macroscopic findings, biopsy is not usually performed and propranolol is first-line treatment. In contrast, ectopic thymus is a rare differential diagnosis for subglottic mass made by histopathological examination after excision or autopsy. In this article, we present a case of an infant with a subglottic lesion with endoscopic features consistent with haemangioma. After initial clinical response to propranolol, the patient represented with progressive stridor no longer responding to therapy. Open excision of the lesion was performed, and histopathology revealed ectopic thymus tissue. In this case, ectopic thymus tissue mimicked the presentation of subglottic haemangioma, and confirmation bias persisted due to an apparent initial clinical response to treatment with propranolol. In cases of subglottic mass refractory to medical treatment, excision of the lesion should be considered.
声门下血管瘤表现为新生儿和婴儿气道进行性阻塞，内镜下可见到柔软的病变。诊断基于宏观发现，通常不进行活检，而是将普萘洛尔作为一线治疗。相比之下，异位胸腺是切除或尸检后组织病理学检查诊断声门下肿块的罕见鉴别诊断。本文报道了 1 例婴儿声门下病变，内镜特征符合血管瘤。最初对普萘洛尔有临床反应，但随后出现对治疗无反应的进行性喘鸣。对病变进行了开放性切除，组织病理学显示为异位胸腺组织。在这种情况下，异位胸腺组织模拟了声门下血管瘤的表现，由于对普萘洛尔治疗有明显的初始临床反应，因此存在确认偏倚。对于药物治疗无效的声门下肿块，应考虑切除病变。
