We report on two periapical lesions of endodontic origin detected in the maxillary bone of the same patient, whose echographic examination was used to address a tentative differential diagnosis between a granuloma and a cystic lesion. The patient on whom two periapical lesions were diagnosed with clinical and conventional radiographic findings and scheduled for endodontic surgery, was also examined using echography and color power doppler at the site of the lesions. The lesions were echographically described in each case according to a scheme from a previous work. A tentative differential diagnosis between a cystic lesion and a granuloma was made. One lesion was described as a cyst, the other as a granuloma. After surgical excision, the lesions were examined under light microscopy. In both cases the two echographic diagnoses were confirmed by the histopathologic examination.