[Postcricoid vascular lesion in an infant].
Pediatric Otolaryngology Unit, Department of Otolaryngology Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.Harefuah 02/2010; 149(2):77-9, 125.
A 7-months-old female presented with coughing spells while feeding. Flexible laryngoscopy revealed a round bluish mass, emanating from the postcricoid area when the child cried or strained and disappeared when she relaxed. She was treated with systemic steroids for a month and was doing well. There was no change in the lesion. On examination at age 18 months the lesion disappeared. In a review of the literature, the authors found 6 articles describing 19 children with postcricoid vascular lesions. Seven children did not have significant related problems and did well without any treatment. Eight cases had significant co-morbidity. Treatment for symptomatic children included systemic or intralesion steroids, laser ablation and open resection. Postcricoid vascular lesion is a rare entity with a typical appearance. The recommended workup includes flexible laryngoscopy and videofluoroscopy. There are several treatment options for symptomatic children.
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ABSTRACT: 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. 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. No PDPCMs demonstrated significant interval change in size or appearance, and eight of ten patients did well with observation. 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.
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ABSTRACT: To describe the cyclical vascular enlargement that occurs in the postcricoid region during the expiratory phase on an infant's cry, and to consider the anatomic, physiologic, and clinical implications of this phenomenon, which we term the "postcricoid cushion." A total of 125 consecutive office fiber-optic laryngoscopic examinations in children and infants were reviewed for engorgement and vascular discoloration of the postcricoid region. Presence of a postcricoid cushion in relation to patient age was reviewed. A comprehensive literature review was also performed. Tertiary care pediatric hospital. Patients from newborns to 17 years old undergoing laryngoscopy for any reason. Sixty-one percent of the videos showed a postcricoid cushion with cyclical enlargement during crying. Eighty-eight percent of children younger than 24 months had presence of a cushion compared with only 38% of children 24 months or older (P < .001). Twenty-five percent of the cushions had violaceous discoloration that resembled a vascular malformation. Anatomic studies have demonstrated a rich venous plexus in the postcricoid region of the larynx. During the expiratory phase of an infant's cry, there is a cyclical engorgement, occasionally with vascular discoloration, in the postcricoid region at the same level of the venous plexus-the "postcricoid cushion." We propose that during crying, with acute elevation in intrathoracic pressure, there is a filling of the plexus, causing apposition of the postcricoid cushion against the posterior pharyngeal wall, which may serve as a protective barrier to emesis in infants. Our observations relate and differentiate this normal physiologic phenomenon from the rare cases of postcricoid vascular anomalies.
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