Utilization of contrast-enhanced ultrasound in the evaluation of craniofacial osseous lesions: A case report

A 14-year-old boy undergoing brain MRI had an incidental avidly enhancing lobulated lesion in the left superolateral orbital rim with associated cortical erosion. Apart from Contrast-enhanced Magnetic Resonance Imaging (MRI), and Computed Tomography (CT), Contrast-Enhanced Ultrasound (CEUS) was obtained prior to a biopsy. It provided additional information about the microvasculature and an orbital biopsy was subsequently performed through an upper eyelid crease incision with minimal blood loss and no postoperative complications. Histopathological examination revealed features which were compatible with the diagnosis of LCH. The authors propose that CEUS may be considered as an adjunct and possibly alternative imaging modality for the evaluation of craniofacial osseous lesions, especially in the orbital region (due to the known radio-sensitivity of the eyes) and in pediatric patients, to minimize the risk of ionizing-radiation exposure. •For osseous lesions involving the bony orbits, biopsy usually required for diagnostic confirmation, and requires evaluation with imaging.•Our patient underwent contrast-enhanced ultrasound (CEUS) prior to surgery which provided additional information on the microvasculature.•CEUS may be considered as an adjunct and possibly alternative imaging modality for the evaluation of highly vascular craniofacial lesions.•Use in the orbital region and in pediatric patients can minimize the radiation of ionizing-radiation exposure.