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CT of Hemangiomas of the Upper Airways in Children

¹ Department of Radiology, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel.
² Institute of Pulmonology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
³ Division of Pediatric Pulmonology, Shaare-Zedek Medical Center, Jerusalem, Israel.

View larger version (129K): [in a new window]   Fig. 1A. —Right posterolateral subglottic hemangioma in 1-month-old boy with stridor. Unenhanced CT scan shows asymmetric narrowing of tracheal lumen (arrow).

View larger version (121K): [in a new window]   Fig. 1B. —Right posterolateral subglottic hemangioma in 1-month-old boy with stridor. CT scan immediately after contrast administration shows intense enhancement of hemangioma (arrow) and greater degree of luminal narrowing after contrast administration. Contrast-enhanced study more optimally shows full extent of lesion, which is semicircumferential, and correlates more closely with findings at bronchoscopy.

View larger version (77K): [in a new window]   Fig. 1C. —Right posterolateral subglottic hemangioma in 1-month-old boy with stridor. Bronchoscopic image shows bilateral nature of hemangioma (arrows), which is larger on right side, and narrowed trachea (asterisk). V = vocal cords.

View larger version (116K): [in a new window]   Fig. 2A. —Symmetric subglottic stenosis (arrows) caused by circumferential hemangioma in 2-month-old girl with noisy breathing. Anteroposterior chest radiograph with patient in supine position shows symmetric bilateral narrowing of the trachea (arrows).

View larger version (102K): [in a new window]   Fig. 2B. —Symmetric subglottic stenosis (arrows) caused by circumferential hemangioma in 2-month-old girl with noisy breathing. Contrast-enhanced axial CT scan shows hemangioma (arrows) with characteristic intense immediate enhancement after IV contrast injection.

View larger version (96K): [in a new window]   Fig. 2C. —Symmetric subglottic stenosis (arrows) caused by circumferential hemangioma in 2-month-old girl with noisy breathing. Image from bronchoscopy shows bronchoscopic appearance of hemangioma (H). V = vocal cords, T = narrowed tracheal lumen.

View larger version (106K): [in a new window]   Fig. 3A. —24-month-old girl with recurrent episodes of acute stridor. Unenhanced axial CT image shows supraglottic hemangioma (arrow).

View larger version (100K): [in a new window]   Fig. 3B. —24-month-old girl with recurrent episodes of acute stridor. Contrast-enhanced axial image (B) and coronal (C) and sagittal (D) reconstructions show soft-tissue mass in right aryepiglottic fold (arrows) with marked enhancement after contrast administration.

View larger version (62K): [in a new window]   Fig. 3C. —24-month-old girl with recurrent episodes of acute stridor. Contrast-enhanced axial image (B) and coronal (C) and sagittal (D) reconstructions show soft-tissue mass in right aryepiglottic fold (arrows) with marked enhancement after contrast administration.

View larger version (85K): [in a new window]   Fig. 3D. —24-month-old girl with recurrent episodes of acute stridor. Contrast-enhanced axial image (B) and coronal (C) and sagittal (D) reconstructions show soft-tissue mass in right aryepiglottic fold (arrows) with marked enhancement after contrast administration.

View larger version (100K): [in a new window]   Fig. 4A. —Supraglottic hemangioma with subglottic and tracheal extension in 14-month-old girl with persistent stridor. Bronchoscopic image at supraglottic level shows marked engorgement of aryepiglottic folds (H). Arrows = vocal cords, T = tracheal lumen.

View larger version (102K): [in a new window]   Fig. 4B. —Supraglottic hemangioma with subglottic and tracheal extension in 14-month-old girl with persistent stridor. Contrast-enhanced axial CT image at same level as A shows intensely enhancing lesion (arrows).

View larger version (65K): [in a new window]   Fig. 4C. —Supraglottic hemangioma with subglottic and tracheal extension in 14-month-old girl with persistent stridor. Bronchoscopic image at subglottic level shows asymmetric bilateral subglottic stenosis caused by tracheal extension of hemangioma (arrows). T = tracheal lumen, V = vocal cords.

View larger version (151K): [in a new window]   Fig. 4D. —Supraglottic hemangioma with subglottic and tracheal extension in 14-month-old girl with persistent stridor. Coronal (D) and sagittal (E) reconstructed CT images show entire length of lesion and degree of tracheal narrowing. These images show lesion extending in spiral manner from subglottic region (arrows) and curving around posterior and lateral wall of trachea (arrows).

View larger version (144K): [in a new window]   Fig. 4E. —Supraglottic hemangioma with subglottic and tracheal extension in 14-month-old girl with persistent stridor. Coronal (D) and sagittal (E) reconstructed CT images show entire length of lesion and degree of tracheal narrowing. These images show lesion extending in spiral manner from subglottic region (arrows) and curving around posterior and lateral wall of trachea (arrows).

View larger version (145K): [in a new window]   Fig. 5A. —Hemangioma in orifice of left main bronchus in 4-month-old girl that caused one-way valve obstructive effect and simulated clinical and imaging features of foreign body. Anteroposterior chest radiograph shows marked hyperinflation of left lung and contralateral mediastinal shift.

View larger version (116K): [in a new window]   Fig. 5B. —Hemangioma in orifice of left main bronchus in 4-month-old girl that caused one-way valve obstructive effect and simulated clinical and imaging features of foreign body. Axial CT scan using soft-tissue window settings at level of carina shows enhancing soft-tissue mass (arrows) in orifice of left main bronchus.

View larger version (85K): [in a new window]   Fig. 5C. —Hemangioma in orifice of left main bronchus in 4-month-old girl that caused one-way valve obstructive effect and simulated clinical and imaging features of foreign body. CT scan using lung window settings at same level as B shows obstructive emphysema of entire left lung secondary to narrowing of orifice of left main bronchus by hemangioma (arrows).

View larger version (111K): [in a new window]   Fig. 5D. —Hemangioma in orifice of left main bronchus in 4-month-old girl that caused one-way valve obstructive effect and simulated clinical and imaging features of foreign body. Bronchoscopic image reveals soft-tissue hemangioma (H) with capillary engorgement bulging into orifice of left main bronchus.

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