It was started as a routine carotid artery ultrasound examination. However, possible surgical correction was considered in this case due to findings.  In order to present this case to a vascular surgeon correctly, we have to use the multiparametric approach. Some of the images are demonstrated below (Fig. 1-4).

Figure 1. Proximal segment of the left Internal carotid artery (left ICA)

Figure 2. Proximal segment of the left internal carotid artery (left ICA) – color Doppler ultrasound study

Figure 3. Left common carotid artery (left CCA) – cross-sectional area for the calculation of carotid artery stenosis

Figure 4. Left common carotid artery (left CCA) – color Doppler ultrasound study

Questions:

1. Please define what type of the plaque you can see on Figure 1 according to the Geroulakos classification (1).

-type I

-type II

-type III

-type IV

-type V

2. What is the degree of stenosis of the left internal carotid artery (ICA) based on Figures 2, 3 and 4?

-0< 50 %

-50 – 69%

- 70%

3. What would you call the color phenomenon when you see green color in the middle of the vessel, where the sample volume is located (Fig. 2)?

-Reverberation

-Aliasing

-Flow reversal

-Blooming 

4. What would you call the color phenomenon when you see blue color at the posterior wall of the ICA, below the sample volume (Fig.2)?

-Reverberation

-Aliasing

-Flow reversal

-Blooming

5. What statement is more accurate if you compare spectral Doppler appearances of the left ICA (Fig. 2) and the left common carotid artery (Fig. 4).

-a poor acoustic window is demonstrated (Fig. 2)

-turbulent flow is demonstrated (Fig. 2)

-acoustic clarity is demonstrated (Fig. 4)

-spectral broadening is demonstrated (Fig. 2)

Ihor Hayda, Mykhaylo Sorokivskyy, Ihor Volodymyr Hayda

Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

Peer-review: internal  and  external

Conflict of interest: None to declare

Authorship:  I.H., M.S., and I.V.H.  have equally contributed to preparation of quiz

Acknowledgement and funding: None to declare