Tracheal Hemangioma: The “Cherry” in the Trachea

A young adult presented with a four-month long history of hemoptysis. A computed tomography (CT) scan showed a mid-trachea lesion (Figure 1). A flexible bronchoscopy was performed and revealed a cherry-like polyp (Figure 2(a)) and biopsy resulted in brisk bleeding. The polyp was coagulated at the base with a Nd-YAG (neodymium doped-yttrium aluminium garnet) laser followed by forceps resection via the rigid bronchoscope (Video). Histology of the 8mmby 10mm lesion was classic of a lobular capillary hemangioma (LCH) (Figure 3). The patient had been asymptomatic since and bronchoscopy performed two years later showed no tumor recurrence (Figure 2(b)). Lobular capillary hemangioma (LCH) is typically found on cutaneous and oronasalmucosa. Tracheobronchial LCH is a rarity [1].Hemoptysis oftenoccurs for a short duration ranging fromweeks to months with the exception of one reported case ofmassive hemoptysis which required arterial embolization. The airway lesion is usually small (<10mm), sessile, or polypoid with a distinctive glinting vascular (cherry) appearance that bleeds easily. Pathogenesis of this benign tumor is unclear and has been correlated to infections, trauma, and hormonal shifts [1].The latter can be supported by the case of a rapidly growing trachea LCH (40mmby 20mm) found in a pregnant lady who presented with critical airway obstruction [2]. The characteristic findings of a homogeneously contrast enhanced lesion seen on CT scan and an airway lesion (as described above) observed during bronchoscopy should lead to a cautious biopsy to clinch the diagnosis. Bronchoscopic ablative intervention often results in a cure although past reports had a follow-up of one year or less. Ablative modalities included endoscopic resection with NdYAG laser, argon plasma coagulation, electrocautery, cryotherapy, and forceps. In one reported case of tumor recurrence, brachytherapy was applied.