Airway obstruction as the primary manifestation of infantile thyroid hemangioma

Abstract

Background: Thyroid hemangioma mostly occurs in adults and is extremely rare in infants. So far, only four pediatric cases of thyroid hemangioma have been reported, one of which has only been clinically diagnosed. Most of the reported cases are of cavernous hemangiomas; capillary hemangioma cases are very rare. To date, there are no reports on capillary thyroid hemangioma in an infant. Therefore, here we present the case of an infant with a primary capillary hemangioma of the thyroid gland, and discuss its treatment and follow-up.

Case presentation: A2-month-old infant with normal thyroid function presented with airway obstruction as the primary manifestation of thyroid hemangioma. The main symptoms were laryngeal wheezing and dyspnea. Ultrasonography revealed hypoechoic lesions at the lower pole of the bilateral thyroid. Computed tomography revealed enlargement of the thyroid gland, inhomogeneous parenchyma enhancement, and multiple thyroid nodules. However, these imaging modalities were unable to provide an exact diagnosis and the nature of the mass remained unknown prior to an operation. Therefore, a postoperative histopathological examination was undertaken, which revealed capillary thyroid hemangioma. The symptoms significantly improved by a combined treatment involving surgery and oral propranolol.

Conclusion: When a well-defined capsulate mass is detected on the medical image, the possibility of primary thyroid hemangioma must be considered.

Keywords: Airway obstruction; Capillary; Case report; Infantile; Thyroid hemangioma.

Fig. 1

Ultrasound image of thyroid hemangioma. a Hypoechoic lesions are observed at the lower pole of the left thyroid and a chord-like hyperechoic lesion is observed within. b Hypoechoic lesions are observed at the lower pole of the right thyroid, and a chord-like hyperechoic lesion is observed within. c Hypoechoic lesions with a clear boundary and abundant blood supply are noted at the lower pole of the bilateral thyroid. d, e, f No recurrence of hemangioma was found

Fig. 2

Non-enhanced and contrast-enhanced CT images of the thyroid hemangioma. a Non-enhanced CT imges show that the slightly hyperattenuated thyroid is enlarged and part of the left lobe stretches into the superior mediastinum. b In the contrast-enhanced CT image, the enlarged thyroid shows heterogeneous nodular enhancement

Fig. 3

Specimen and histopathological picture of the excised thyroid mass. Capillary dilation can be seen, and solid cord changes are visible (H&E staining,40×)