From the Guidelines
Imaging for laryngeal hemangioma should primarily involve magnetic resonance imaging (MRI) with IV contrast to accurately determine the extent of the lesion and its impact on surrounding structures, as recommended by the most recent guidelines 1. When evaluating laryngeal hemangiomas, it is crucial to consider the potential impact on airway patency and the need for detailed visualization of the lesion.
- Direct laryngoscopy is typically the initial diagnostic approach, allowing for direct visualization of the lesion and assessment of airway patency.
- For comprehensive evaluation, MRI is preferred due to its superior soft tissue contrast and ability to distinguish hemangiomas from other vascular lesions without radiation exposure, as noted in the American College of Radiology guidelines 1.
- MRI with gadolinium contrast enhancement is particularly valuable as it demonstrates the characteristic bright signal intensity and enhancement pattern of hemangiomas.
- Computed tomography (CT) with contrast may be used when MRI is unavailable or contraindicated, providing good visualization of the extent of the lesion and any calcifications, especially in cases where optimal imaging of the airway is required 2.
- Ultrasound with Doppler can be helpful in pediatric patients to assess blood flow patterns and monitor treatment response without radiation.
- Angiography is rarely needed but may be considered for complex cases or when planning surgical intervention. These imaging studies help determine the size, extent, and vascularity of the hemangioma, which guides treatment decisions including observation, medical therapy with propranolol, or surgical intervention.
From the Research
Imaging Modalities for Laryngeal Hemangioma
- Computed Tomography (CT) scans are commonly used for laryngeal imaging due to their widespread availability and ease of acquisition 3.
- Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) are used as problem-solving tools for laryngeal pathology 3.
- Dual-energy CT can be used to evaluate cartilage invasion in laryngeal and hypopharyngeal cancer, with combined iodine overlay images and weighted average images 4.
Diagnosis of Laryngeal Hemangioma
- Contrast-enhanced CT scans can be used to diagnose subglottic hemangiomas, which may be missed on flexible laryngoscopy or bronchoscopy 5.
- Imaging techniques such as CT and MRI can be used to evaluate the location and extent of laryngeal hemangiomas, and to plan treatment 6, 7.
Challenges in Imaging Laryngeal Hemangioma
- Laryngeal hemangiomas can be difficult to diagnose due to their rare occurrence and non-specific symptoms 6, 7.
- Imaging modalities such as CT and MRI may not always be able to distinguish between hemangiomas and other laryngeal lesions, such as chondrosarcomas 7.
- The presence of an endotracheal tube can make it difficult to diagnose airway hemangiomas on bronchoscopy and CT scans 5.