Contrast‑enhanced ultrasound-guided sclerotherapy of vascular malformations in the head and neck: Initial clinical experience in a paediatric case series

Purpose: Vascular malformations of the head and neck pose therapeutic challenges due to complex anatomy and proximity to critical structures. Percutaneous sclerotherapy guided by digital subtraction angiography is effective for low-flow malformations but involves radiation and iodinated contrast. Contrast-enhanced ultrasound offers a radiation-free alternative with real-time visualisation of intralesional contrast. Methods: We retrospectively analysed contrast-enhanced ultrasound-guided sclerotherapy procedures for head and neck malformations in children under 6 years performed since 2021, assessing feasibility, safety and clinical outcomes. Six interventions in six patients (44 days to 3.5 years) were included. Results: Contrast-enhanced ultrasound confirmed intralesional needle placement in all cases without evidence of extralesional contrast leakage. Sclerotherapy with Fibrovein or Aethoxysklerol was successfully performed in every procedure. No contrast-related adverse events occurred and all patients showed at least temporary clinical improvement. Conclusions: Contrast-enhanced ultrasound therefore appears feasible and safe for guiding sclerotherapy of venolymphatic malformations in the head and neck, enabling real-time verification without ionising radiation or iodinated contrast. The technique may be particularly valuable in paediatric patients requiring repeated interventions.