Postcricoid vascular anomalies in pediatrics: Case report and literature review

Postcricoid vascular alterations are infrequent entities in otorhinolaryngology. Most Postcricoid vascular alterations correspond to anatomical variations of the vascular plexuses that depend on changes in abdominal pressure. CLINICAL CASE: Infant consultation for recurring upper respiratory infections associated with dysphonia and stridor while crying. Physical examination: nasal and oral cavity without pathological findings. Flexible endoscopy: vascularized tumor in postcricoid region, variable with crying. Neck MRI: Hyperintense linear postcricoid image in T2 and STIR sequences. Patient was managed cautiously, evolving with regression of symptoms and progressive regression of vascular tumor. DISCUSSION: Postcricoid vascular anomalies are venous proliferations that resemble a variable vascularized mass with changes in abdominal pressure. These alterations would be secondary to hypopharyngeal venous “cushions” or plexuses that regress with age. The symptoms vary and can present in infants with stridor, dysphonia, apneas, dysphagia, and even slow weight gain. These lesions are identifiable by awake flexible laryngoscopy and are not evidenced by rigid laryngoscopy or imaging under anesthesia unless Valsalva or Trendelenburg maneuvers are used. It is recommended to rule out synchronous lesions in the aerodigestive tract. Differential diagnoses are congenital laryngeal vascular anomalies and postcricoid hemangiomas, which are not altered with pressure changes. Treatment will depend on the severity of the symptoms. CONCLUSIONS: Hypopharyngeal venous plexuses are entities that are not much described in literature. They can cause a variety of symptoms and should always be considered in infants with aerodigestive symptoms and postcricoid abnormalities.