(004) A Case of Subglottic Pyogenic Granuloma

Introduction: The objectives are to report an unusual case of laryngeal pyogenic granuloma and to synthesize the available literature on diagnosis and management.

Methods: This is a case report and literature review. The patient’s history, exam, endoscopic, and operative findings were recorded. A search of key terms (“laryn*” or “subglott*”) and (“pyogenic granuloma” or “lobular capillary hemangioma”) was performed in PMC.

Results: Patient is a 48 year old male smoker with schizophrenia, who was admitted for severe lower extremity burns. He was intubated for 20 days in the setting of cardiovascular arrest and respiratory failure and underwent tracheotomy. During fiberoptic endoscopic evaluation of swallowing, a subglottic nodule was noted, confirmed on CT as a left paramedian subglottic soft tissue mass. Patient underwent direct laryngoscopy, debulking, and steroid injection. Pathology demonstrated pyogenic granuloma. Limited case reports and small case series of laryngeal pyogenic papilloma exist in the literature, primarily in adult patients and of the false and true vocal folds. Potential predisposing factors have included trauma, intubation, smoking, pregnancy, and reflux. A series of congenital lesions in neonates has been reported. Management have included excision, KTP and CO2 laser, steroid injection, systemic steroid, and reflux management. Recurrence is reported in a minority of cases.

Conclusions: Laryngeal pyogenic granuloma is infrequently reported in the literature. This diagnosis should be considered in patients with predisposing factors to tailor therapy.