Diagnostic dilemma in an infant with stridor: ultrasound to the rescue!

Stridor is one of the most important signs of partial or complete upper airway obstruction. Subglottic hemangioma (SGH) is a well-recognized however infrequent cause of infantile stridor. It is a potentially life-threatening condition. Thus, early diagnosis and management are crucial. Diagnostic evaluation includes ultrasound, cross-sectional imaging such as contrast-enhanced CT/MRI, and tracheobronchoscopy. Ultrasound (US), although not a widely used modality for the diagnosis, provides good assessment of its presence, extent, and degree of subglottic airway narrowing. Moreover, color Doppler helps to establish the vascular nature of the lesion. There are many advantages of US over tracheobronchoscopy and CT in an emergency setting which include its easy availability, non-invasive nature, and can be done quickly as a bedside procedure, enabling early initiation of treatment. However, there are some disadvantages as well, which include limited field of view and operator dependency. Also, extension into the thoracic cavity and more deeply located soft tissue locations can be missed. We present a case of subglottic hemangioma in which US solved the diagnostic dilemma and provided a definite diagnosis when CT and tracheobronchoscopy failed to do so in a 6-month-old infant presenting with stridor to the ER.