[Contrast enhanced ultrasound can show symptomatic carotid lesions not visualized with magnetic resonance...

We report the cases of two patients who presented symptoms focused on a wall of the common carotid: carotidodynia in one patient and a transient ischemic attack in the other. The B-mode ultrasound showed an enlarged thickened medio-adventitial echostructure with a slightly heterogeneous and iso or hypoechoic appearance. There was no narrowing. Injection of ultrasound contrast led to significant enhancement in the wall reflecting neovascularization secondary to inflammation. Other imaging methods (MR and CT angiography) found no abnormality. At the 3-month follow-up visit, the surface area of the lesions was greatly decreased and the ultrasound contrast enhancement had disappeared. These two cases illustrate how focal lesions of the carotid wall missed on MR and CT angiography can be detected and visualized with B-mode ultrasound contrast enhancement. Contrast enhanced ultrasound leads to the concept of "active lesions" resulting from inflammatory processes that can be readily monitored without radiation.