CASE REPORT
A 3-month-old female patient presented a red-wine colored macular lesion
at birth in the right preauricular region of 1 cm, which progressively
increased volume and size.
A month before admission (January 2019), the patient was evaluated by
the dermatology department, that indicate a biopsy that evidence the
presence of the hemangioma (Figure 1). A soft tissue ultrasound showed
evidence compatible with an extensive submandibular glandular
hemangioma with high-flow arterial compromise and high resistance, in
addition to multiple arteriovenous shunts.
The hemangioma continued to grow, and the patient presented episodes of
demanding dry cough and nasal discharge one week before being admitted
to the hospital. She received treatment with antipyretics and
antibiotics for five days. Two days before admission, the hemangioma
continued to increase in volume and size, and the patient experienced
shortness of breath during sleep with deep inspiration, cough associated
with difficulty in breastfeeding and feverish sensation for which she
came to the emergency department at Belen Hospital in Trujillo, Peru.
Upon admission, the patient presented with mild respiratory distress at
rest and difficulty during lactation. They described a 15cm long by
7.5cm wide hemangioma located in the submandibular, preauricular and
right malar region (Figure 2) with purplish color, telangiectasias
disseminated inside, not mobile nor painful on palpation. In addition,
the presence of another 3 cm of diameter hemangioma at the midline of
the upper third of the left hemithorax. Treatment with propranolol is
started to decrease the size of the hemangioma.
A chest x-ray showed airway displacement, and the otorhinolaryngology
service suggested endotracheal intubation, verifying displacement of the
trachea. The patient is transferred to the ICU and is started in
mechanical ventilation. She experienced a fever peak, so laboratory
tests were requested, including blood and urine culture. A globular
package is transfused due to a drop in hemoglobin and antibiotic
treatment is started due to a pathological urine test.
During hospitalization, she presented a desaturation episode attributed
to the mass effect produced by the hemangioma. On physical examination,
a decrease in vesicular murmur is evident in the right hemithorax,
expiratory wheezing, and subcrepits. Control x-ray showed evidence of a
consolidation pattern in the right hemithorax. The patient started
double antibiotic coverage, atenolol instead of propranolol and
corticosteroid therapy.
On the fourth day of hospitalization, the patient presented
cardiorespiratory arrest. Treatment with captopril is started orally due
to increased blood pressure. Respiratory symptoms were clinically
stationary but had progressive reduction of the hemangioma dimensions.
On the ninth day, she presented a feverish peak and got switched to a
broad-spectrum antibiotic coverage with gradual suspension of
corticosteroid.
During the tenth day of hospitalization, the patient was extubated,
tolerating spontaneous ventilation with mild stridor and aphonia,
nebulized with adrenaline and restarting corticosteroid therapy. The
patient was transferred to another hospital where she continued with
antibiotic treatment, atenolol and captopril with favorable evolution
and reduction of the hemangioma. She is discharged with oral antibiotic
treatment and indication of outpatient center control.
The patient continues with the follow up in the other hospital until
today, on May 2020 she does not have any complication or recurrence of
the tumor.