Paediatric orbital ultrasound: Tips and tricks

Abstract

Background The orbital structures are ideally suited for ultrasound examination due to their superficial location and cystic composition of the eye. However, orbital ultrasound remains an underutilised modality due to preference for other cross‐sectional modalities in general practice. Aim In this article, we review the basic principles, clinical uses and technique of orbital ultrasound in peadiatric patients. Materials and methods The clinical utility of orbital ultrasound in peadiatric patients is demonstrated using selected cases. Results Ultrasound is useful in the diagnosis of various posterior segment pathologies, especially in conditions causing opacification of light‐conducting media of the eye. It is also beneficial in diagnosing various orbital pathologies, particularly in differentiating solid from cystic lesions. Discussion The added advantages of its use in children include lack of ionising radiation and reduced requirement of sedation or general anesthesia. Ultrasound is the most practical initial investigation in cases where ophthalmoscopy is limited by opacification of ocular media. The addition of color Doppler on ultrasound can give additional information about the vascularity of the lesion. Conclusion Use of ultrasound can be streamlined into the workup of various orbital and ocular pathologies either as an initial investigation or as a problem‐solving tool in cases with a diagnostic dilemma on other modalities.

Assessing the Usefulness of Ultrasonography for the Diagnosis and Evaluation of Intra‐Orbital Lesions in Pediatric Patients

“…To assess the usefulness of ultrasonography, following image findings were evaluated: Lesion detection rate was defined as the presence (Figures 2–8) or absence (Figures 9 and 10) of a lesion based on ultrasound findings. Lesion side and location: The lesion side was defined as right or left, and lesion location was classified into the following two locations: extraconal (Figures 2, 4, 7–10) and intraconal (Figures 3, 5, and 6). Lesion characteristics were defined according to the following five categories on the basis of sonographic findings reported in previous studies 4,5,9,11,14,17–21 : 1) suspected aggressive malignant lesion (rhabdomyosarcoma [Figure 2] or other small round cell tumor) based on the presence of hypervascular solid lesion with irregular borders with or without destruction of the surrounding tissues; 2) suspected nonaggressive malignant lesion (soft tissue tumor, non‐small round cell tumor [Figure 3]) based on the presence of solid lesion with regular borders without destruction of the surrounding tissues or hypervascularity; 3) suspected hypervascular tumor (hemangioma) (Figures 4 and 5) based on the presence of hypervascular solid lesion with regular and smooth borders; 4) cystic lesion with hypervascular area (arteriovenous malformation [AVM]) (Figure 6) based on the presence of hypervascular cystic lesion; and 5) cystic lesion without hypervascular area (lymphangioma [Figure 7], abscess [Figures 8 and 9], epidermoid or epithelial cystic lesion [Figure 10]) based on the presence of a cystic lesion without vascular flow. Lesion size: Length (longitudinal), width, and height of the lesion were measured. Among these measurement, the longest linear dimensions were selected.…”

“…To assess the usefulness of ultrasonography, following image findings were evaluated: 3. Lesion characteristics were defined according to the following five categories on the basis of sonographic findings reported in previous studies 4,5,9,11,14,[17][18][19][20][21] : 1) suspected aggressive malignant lesion (rhabdomyosarcoma [Figure 2] or other small round cell tumor) based on the presence of hypervascular solid lesion with irregular borders with or without destruction of the surrounding tissues; 2) suspected nonaggressive malignant lesion (soft tissue tumor, non-small round cell tumor [Figure 3]) based on the presence of solid lesion with regular borders without destruction of the surrounding tissues or hypervascularity;…”

“…8,9,14,17,18 However, no study has focused on intra-orbital lesions that are difficult to evaluate using ultrasonography techniques. 9,11,14,[18][19][20] The purpose of this study was to evaluate the usefulness of ultrasonography in diagnosing and characterizing extraocular intra-orbital lesions in pediatric patients. Moreover, we also aimed to describe the factors that affect the difficulty of evaluating extraocular intra-orbital lesions using ultrasonography.…”

“…In addition to these modalities, ultrasound has been reported to be useful for evaluating extraocular intra‐orbital lesions 8,9,14,17,18 . However, no study has focused on intra‐orbital lesions that are difficult to evaluate using ultrasonography techniques 9,11,14,18–20 …”