Subglottic hemangioma posterior lateral position is most common and left >right, rarely calcify.

Hemangiomas arises by endothelial hyperplasia whereas vascular malformations arise by dysmorphogenesis and exhibit normal endothelial turnover.

Subglottic hemangiomas -1.5% congenital anomalies of the larynx.

Cutaneous hemangiomas are seen in 50% of cases.

PHACE SYNDROME:

P-Posterior fossa brain malformation

H-Hemangiomas

A-Arterial anomalies

C-Coarctation of aorta, cardiac defects

E-Eye abnormalities

7% have subglottic hemangiomas

Kasabach-Merritt Syndrome-Rarely associated with subglottic hemangioma. Usually seen with hemangioendothelioma of liver and with thrombocytopenia.

Differential Diagnosis:

Subglottic stenosis

Tracheal granuloma

Viral croup

Membranous croup

Tracheal papillomatosis

Treatment;

Conservative monitoring

Steroids

Co2 laser therapy

Laryngotracheoplasty

Interferon

Vincristine

Direct excision of subglottic hemangioma

Take Home Message:

In croup  there is symmetrical narrowing with loss of shoulders on both sides(Steepel Sign)

In subglottic hemangioma loss of shouder on one side.( See the figure and line drawing)