Contrast-enhanced ultrasound patterns in pediatric soft-tissue vascular anomalies: a single-center pictorial essay

Vascular anomalies comprise a heterogeneous group of disorders frequently encountered in the pediatric population, and their clinical presentation may be complex or overlapping. Ultrasound is the first-line imaging modality because of its wide availability, lack of ionizing radiation, and ability to provide real-time assessment of lesion morphology and vascularity. However, conventional ultrasound may have limitations in detecting very slow blood flow and in comprehensively characterizing lesion perfusion. Contrast-enhanced ultrasound can provide additional real-time hemodynamic information in selected superficially accessible lesions without the use of ionizing radiation and, in many cases, without the need for sedation. The purpose of this pictorial essay is to illustrate and describe the spectrum of contrast-enhanced ultrasound enhancement patterns observed in pediatric vascular anomalies and to correlate these findings with conventional ultrasound features. Representative cases from a single tertiary referral center are presented, including infantile hemangioma, congenital hemangioma, venous malformation, arteriovenous malformation, lymphatic malformation, and capillary malformation. Particular emphasis is placed on the characteristic enhancement patterns demonstrated on contrast-enhanced ultrasound, together with their corresponding B-mode, color Doppler, and spectral Doppler findings. The illustrated cases highlight the different perfusion characteristics that may be encountered across the spectrum of pediatric vascular anomalies, reflecting their underlying vascular architecture and flow dynamics. Recognition of these enhancement patterns may facilitate lesion assessment and improve familiarity with the potential applications of contrast-enhanced ultrasound in this setting. Contrast-enhanced ultrasound should be regarded as a complementary imaging technique that provides dynamic visualization of lesion perfusion. Although not intended to replace established imaging pathways, it may offer useful additional information in selected cases, while magnetic resonance imaging remains the modality of choice for evaluating lesion extent and deep tissue involvement.