The intravascular insonation of a blood vessel in the presence of an impedance interface between blood and the inner vessel wall is studied theoretically, The model, which uses a ray approximation, is three dimensional and allows consideration of arbitrary noncircular lumen shapes, Model results are presented for the image geometry, and the insonating intensity over the vessel wall, It is shown that the inner lumen can be imaged accurately with the transducer at any position within the lumen, and at any forward viewing angle, provided the point of origin of the beam is stationary, If it is not stationary but rotating with the same angular velocity as the beam itself, the inner vessel wall is not mapped accurately, A particular geometric distortion which has been observed in practice is predicted if the transducer is near the vessel wall, Acoustic impedance interfaces will be encountered in vascular disease because the speed of sound in fatty plaque is less than in blood, whereas the speed of sound in fibrous and calcified plaque is greater than in blood, A simplified model representation of an atherosclerotic lumen is developed using a cardioid-like curve and a single impedance interface, Model results show that refraction at this interface leads to an intensity distribution which is not uniform around the lumen, and which depends on lumen shape and transducer position, The exception is the special case of a circular lumen with a centrally positioned transducer, Noncircular impedance interfaces encountered in vivo in vascular disease may cause considerable intensity distortion, particularly if the transducer is close to the wall in an irregularly shaped lumen.