Carotid Plaque Characterization Using Contrast-Enhanced Ultrasound: A Case Report

A slightly hypoechoic attachment was observed at the distal end of the plaque, exhibiting slight movement synchronous with carotid artery pulsation. Color Doppler flow imaging (CDFI) also demonstrated a suspicious filling defect. To further elucidate the diagnosis, a contrast-enhanced ultrasound (CEUS) examination was conducted following informed consent from the patient. The CEUS revealed multiple neovascularizations within the slightly hypoechoic plaque (Figure 1). Additionally, a local discontinuity of the fibrous cap, measuring approximately 1.4 mm wide and 4.0 mm deep, was observed on the plaque's surface, 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. The distal end of this low hypoechoic structure appeared free within the lumen (Figures 3 and 4), demonstrating a slight swinging motion. Notably, the low hypoechoic area did not exhibit any enhancement during the CEUS examination.