Point-of-care ultrasound identification of a Calvarial hemangioma in the emergency department: a case report.

Calvarial intraosseous hemangiomas are rare, benign vascular tumors arising from the intrinsic vasculature of bone. They account for approximately 0.2% of all benign osseous neoplasms and 2% of calvarial tumors. They most commonly present as localized, progressive scalp swelling with headache and are diagnosed using computed tomography (CT) or magnetic resonance imaging (MRI). Reports describing the sonographic appearance of calvarial intraosseous hemangiomas are exceedingly limited, and no cases have been reported in which point-of-care ultrasound (PoCUS) was used for evaluation in the emergency department (ED) setting. We present the case of an otherwise healthy 22-year-old woman who presented to the ED with a four-day history of a tender right parietal scalp mass and localized headache. PoCUS demonstrated a well-circumscribed lesion arising from the calvarium with superficial swelling, rather than an isolated soft-tissue lesion which was suspected based on history and examination. An MRI was subsequently ordered and demonstrated an enhancing calvarial lesion favored to represent a calvarial intraosseous hemangioma. The patient was referred to neurosurgery for further evaluation and management. Although CT and MRI remain the diagnostic standards for calvarial intraosseous hemangiomas, this case demonstrates the potential value of PoCUS as a rapid bedside tool for distinguishing superficial scalp lesions from underlying osseous pathology and guiding prompt advanced imaging.