Adult Laryngeal Haemangioma Misdiagnosed as Obstructive Sleep Apnoea

Objectives: To describe a case of airway compromise in a 34-year-old man who suffered complications due to an earlier misdiagnosis of a laryngeal haemangioma as obstructive sleep apnoea.

Methods: A case report and review of the literature.

Case Report: A 34-year-old Caucasian man presented with acute onset haemoptysis and dyspnoea, on an 8-month progressive history of a foreign body sensation in the throat. Nasendoscopy revealed a large vascular mass occupying the pharynx and larynx, causing intermittent and frequent airway obstruction. The patient suffered from a cardiorespiratory arrest, and underwent emergency resuscitation, cricothyroidotomy and subsequent tracheostomy. Once stabilised, a planned excision of the mass was conducted and histology confirmed it to be a benign haemangioma. A Respiratory review had been undertaken two years previously and a clinical diagnosis of obstructive sleep apnoea concluded, following sleep studies. A nasendoscopy had never been performed. Following excision of the lesion his apnoea resolved; suggesting it was the cause of his obstructive sleep apnoea.

Conclusions: The evaluation of patients with suspected obstructive sleep apnoea should be conducted with a multidisciplinary approach involving both Respiratory and Otolaryngology teams. We suggest that as part of their work-up, all patients should undergo nasendoscopic examination of the upper aerodigestive tract in order to exclude mechanical causes of airway obstruction.

Keywords: Haemangioma, Larynx, Obstructive sleep apnoea, Tracheostomy.