Pyogenic Granuloma of the Lower Airway- A Systematic Review
Introduction: Pyogenic granulomas (PGs) are benign lesions that are very common in the upper aerodigestive tract. These lesions occur due to hormonal imbalance or due to a predisposing traumatic factor. They are relatively rare in the lower respiratory tract. There are few published papers of PG inv...
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JCDR Research and Publications Private Limited
2022-06-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://www.jcdr.net/articles/PDF/16496/53755_CE[Nik]_F(SHU)_PF1(AsG_KM)_PFA(AsG_KM)_PN(KM).pdf |
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| author | VM Lakshana Deve R Sithananda Kumar @Venkatesan TC Vikram Raj Mohanam RG Arthy Jayapriya Djamboulingam Mary Kurien |
| author_facet | VM Lakshana Deve R Sithananda Kumar @Venkatesan TC Vikram Raj Mohanam RG Arthy Jayapriya Djamboulingam Mary Kurien |
| author_sort | VM Lakshana Deve |
| collection | DOAJ |
| description | Introduction: Pyogenic granulomas (PGs) are benign lesions that are very common in the upper aerodigestive tract. These lesions occur due to hormonal imbalance or due to a predisposing traumatic factor. They are relatively rare in the lower respiratory tract. There are few published papers of PG involving the lower airway in the past 30 years.
Aim: A case of pyogenic granuloma of larynx mimicking malignancy has been presented along with the systematic review on methods of diagnosis, successful management, and prevention of pyogenic granuloma recurrence in the lower respiratory tract.
Materials and Methods: This systematic review of literature included reports from 1981 till date, where complete details of the records were available. These reports were collected from the search engines “PubMed” and “Google Scholar” using the MeSH terms “pyogenic granuloma” OR “lobular capillary haemangioma” AND “lower respiratory tract”. The results were reviewed by three different authors independently with a main focus on methods of diagnosis and successful management and prevention of recurrence.
Results: A 59-year-old male patient presented to ENT Department with hoarseness of voice for the past six months. On examination with video laryngoscope, a pale pinkish polypoidal mass originating from the anterior commissure and extending into the subglottic wedge with normal vocal cord mobility was noted. Neck examination showed splaying of thyroid cartilage with tenderness and there were no palpable lymph nodes. Computed Tomography (CT) examination suggested a neoplastic etiology of thyroid cartilage erosion. The patient was managed by microlaryngeal excision of the mass and histopathological analysis revealed pyogenic granuloma with no evidence of malignancy. From the 25 papers reviewed, a predisposing trauma like a history of intubation/lower airway procedures like bronchoscopy or laryngoscopy is not a prerequisite for the occurrence of PG of the lower airway. The lesions can be excised via microlaryngoscopy or using the bronchoscope depending on the site of lesion. The various surgical modalities used for excision are cold steel dissection, laser excision and cryotherapy.
Conclusion: Meticulous dissection and removal of the lesion with postoperative measures to prevent additional trauma like antireflux measures and appropriate antibiotic therapy seems to be helpful in preventing recurrence. Role of steroids in the management of pyogenic granuloma has not been supported by adequate literature. Further studies are required to comment on the adequacy of duration of follow-up. |
| first_indexed | 2024-04-10T15:25:52Z |
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| language | English |
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| publishDate | 2022-06-01 |
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| spelling | doaj.art-71a417331f7a449bbd3d8d5735ae675e2023-02-14T09:12:45ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2022-06-01166ME01ME0810.7860/JCDR/2022/53755.16496Pyogenic Granuloma of the Lower Airway- A Systematic ReviewVM Lakshana Deve 0R Sithananda Kumar @Venkatesan1TC Vikram Raj Mohanam2RG Arthy3Jayapriya Djamboulingam4Mary Kurien 5Assistant Professor, Department of ENT, Pondicherry Institute of Medical Sciences, Puducherry, India.Associate Professor, Department of ENT, Pondicherry Institute of Medical Sciences, Puducherry, India.Associate Professor, Department of ENT, Pondicherry Institute of Medical Sciences, Puducherry, India.Postgraduate Resident, Department of ENT, Pondicherry Institute of Medical Sciences, Puducherry, India.Senior Resident, Department of ENT, Pondicherry Institute of Medical Sciences, Puducherry, India.Professor and Head, Department of ENT, Pondicherry Institute of Medical Sciences, Puducherry, India.Introduction: Pyogenic granulomas (PGs) are benign lesions that are very common in the upper aerodigestive tract. These lesions occur due to hormonal imbalance or due to a predisposing traumatic factor. They are relatively rare in the lower respiratory tract. There are few published papers of PG involving the lower airway in the past 30 years. Aim: A case of pyogenic granuloma of larynx mimicking malignancy has been presented along with the systematic review on methods of diagnosis, successful management, and prevention of pyogenic granuloma recurrence in the lower respiratory tract. Materials and Methods: This systematic review of literature included reports from 1981 till date, where complete details of the records were available. These reports were collected from the search engines “PubMed” and “Google Scholar” using the MeSH terms “pyogenic granuloma” OR “lobular capillary haemangioma” AND “lower respiratory tract”. The results were reviewed by three different authors independently with a main focus on methods of diagnosis and successful management and prevention of recurrence. Results: A 59-year-old male patient presented to ENT Department with hoarseness of voice for the past six months. On examination with video laryngoscope, a pale pinkish polypoidal mass originating from the anterior commissure and extending into the subglottic wedge with normal vocal cord mobility was noted. Neck examination showed splaying of thyroid cartilage with tenderness and there were no palpable lymph nodes. Computed Tomography (CT) examination suggested a neoplastic etiology of thyroid cartilage erosion. The patient was managed by microlaryngeal excision of the mass and histopathological analysis revealed pyogenic granuloma with no evidence of malignancy. From the 25 papers reviewed, a predisposing trauma like a history of intubation/lower airway procedures like bronchoscopy or laryngoscopy is not a prerequisite for the occurrence of PG of the lower airway. The lesions can be excised via microlaryngoscopy or using the bronchoscope depending on the site of lesion. The various surgical modalities used for excision are cold steel dissection, laser excision and cryotherapy. Conclusion: Meticulous dissection and removal of the lesion with postoperative measures to prevent additional trauma like antireflux measures and appropriate antibiotic therapy seems to be helpful in preventing recurrence. Role of steroids in the management of pyogenic granuloma has not been supported by adequate literature. Further studies are required to comment on the adequacy of duration of follow-up.https://www.jcdr.net/articles/PDF/16496/53755_CE[Nik]_F(SHU)_PF1(AsG_KM)_PFA(AsG_KM)_PN(KM).pdflarynxlobular capillary haemangiomatracheobronchial tree |
| spellingShingle | VM Lakshana Deve R Sithananda Kumar @Venkatesan TC Vikram Raj Mohanam RG Arthy Jayapriya Djamboulingam Mary Kurien Pyogenic Granuloma of the Lower Airway- A Systematic Review Journal of Clinical and Diagnostic Research larynx lobular capillary haemangioma tracheobronchial tree |
| title | Pyogenic Granuloma of the Lower Airway- A Systematic Review |
| title_full | Pyogenic Granuloma of the Lower Airway- A Systematic Review |
| title_fullStr | Pyogenic Granuloma of the Lower Airway- A Systematic Review |
| title_full_unstemmed | Pyogenic Granuloma of the Lower Airway- A Systematic Review |
| title_short | Pyogenic Granuloma of the Lower Airway- A Systematic Review |
| title_sort | pyogenic granuloma of the lower airway a systematic review |
| topic | larynx lobular capillary haemangioma tracheobronchial tree |
| url | https://www.jcdr.net/articles/PDF/16496/53755_CE[Nik]_F(SHU)_PF1(AsG_KM)_PFA(AsG_KM)_PN(KM).pdf |
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