A Unique Case of Beard-Distributed Infantile Hemangioma With Subglottic Extension and Evaluation for PHACE Syndrome

We present the case of a 7-week-old female with a segmental, beard-distributed infantile hemangioma, and acute upper airway obstruction. The patient presented with progressive stridor and respiratory distress, prompting urgent evaluation. Bedside flexible laryngoscopy was inconclusive due to patient distress, but operative direct laryngoscopy and bronchoscopy revealed near-circumferential subglottic hemangioma, necessitating endotracheal intubation for airway protection. She was transferred to a tertiary care center for multidisciplinary evaluation and management. Given the distribution of the hemangioma and airway involvement, PHACE syndrome was strongly considered. MRI and MRA of the brain and neck demonstrated no cerebral or large vessel anomalies, though extensive hemangiomatous involvement of the facial and deep neck soft tissues was noted. Echocardiogram and ophthalmologic evaluations were unremarkable. The patient underwent direct laryngoscopy, bronchoscopy, and intralesional Kenalog injection into the supraglottic and subglottic hemangioma. Propranolol was initiated with favorable clinical and radiographic responses. This case emphasizes the importance of early airway evaluation in infants with beard-distributed hemangiomas and highlights the role of comprehensive PHACE syndrome workup. It demonstrates the utility of early propranolol therapy and steroid injection in the management of airway-compromising hemangiomas.