Contrast-enhanced sonography as a novel tool for assessment of vascular malformations

Background: Vascular malformations with arteriovenous shunt components can cause significant disability, chronic pain, and functional impairment. Effective treatment may require serial procedures, yet an imaging modality optimized to control cost and reduce radiation exposure in this predominantly pediatric population has not yet been identified. Methods and Results: We describe the use of contrast-enhanced sonography as a novel tool to define vascular anatomy and localize arteriovenous shunting in a young patient with a symptomatic vascular malformation. Conclusions: This method may effectively reduce radiation exposure and cost, and additionally provide unique information about arteriovenous shunting, offering a novel imaging application for patients with these conditions. Background Vascular malformations (VM) are congenital lesions with diverse clinical manifestations. In contrast to hemangiomas, a separate category of vascular tumors which tend to involute spontaneously, VM often grow in proportion with the child but may expand at an accelerated pace [1]. VM can occur throughout the body, involve multiple vessel types, and may be localized or extensive [2]. Although criteria have been developed for classifying vascular malformations according to flow velocity and vessel type [3], diagnosis of these heterogeneous lesions remains challenging. While these abnormalities may be asymptomatic, VM become clinically important when associated with disfigurement, functional impairment, pain, infection, and serious bleeding [4,5]. These patients require treatment, which varies according to the specific lesion, its location, functional impairment, and goals of therapy. Assembly of a multi-disciplinary team is advantageous when planning therapy. Further, precise characterization of problematic lesions is critically important both in designing the approach and understanding, likely outcomes (such