CEUS Reveals Carotid Plaque with Intraplaque Neovascularization and Mobile Thrombus: A Case Report and Correction

CEUS Reveals Carotid Plaque with Intraplaque Neovascularization and Mobile Thrombus: A Case Report and Correction

Correction:

A slightly hypoechoic attachment was initially observed at the distal end of the carotid plaque, exhibiting slight movement with carotid artery pulsation. Color Doppler flow imaging (CDFI) also indicated a suspicious filling defect. To obtain a definitive diagnosis, a contrast-enhanced ultrasound (CEUS) examination was conducted with informed consent from the patient.

CEUS Findings:

The CEUS examination revealed multiple neovascularizations within the slightly hypoechoic plaque (Figure 1). Additionally, there was a local discontinuity of the fibrous cap on the plaque's surface, measuring approximately 1.4 mm wide and 4.0 mm deep, filled with contrast agent (Figure 2). A low hypoechoic attachment, approximately 7.8 x 3.2 mm in size, was identified at the far proximal shoulder of the plaque. Notably, the low hypoechoic end of this attachment was freely mobile within the lumen (Figures 3 and 4), demonstrating a slight swinging motion. No enhancement was observed within the low hypoechoic area during CEUS.

Discussion:

This case highlights the limitations of conventional ultrasound in characterizing carotid plaque and emphasizes the value of CEUS in providing a comprehensive assessment. The initial interpretation of a 'slightly hypoechoic attachment' proved inaccurate. CEUS clearly demonstrated intraplaque neovascularization, a significant risk factor for stroke, and identified the mobile structure as a thrombus, not simply an attachment.

Conclusion:

CEUS is a valuable tool for the accurate evaluation of carotid plaque morphology and the detection of high-risk features such as neovascularization and thrombus formation. This case underscores the importance of utilizing advanced imaging modalities like CEUS to guide clinical management and reduce the risk of stroke in patients with carotid artery disease.