A duplex image of the carotid bifurcation showing a goblet-like configuration of the ICA and ECA branches suggests:

The goblet-like configuration of the Internal Carotid Artery (ICA) and External Carotid Artery (ECA) branches typically indicates the presence of a carotid body tumor. This type of tumor can cause an alteration in the normal anatomical configuration of the vessels at the carotid bifurcation due to its mass effect. The tumor often results in a characteristic outward bulging or abnormal shape of these arteries, resembling a goblet, as it displaces or encroaches on them.

In contrast, conditions like fibromuscular dysplasia tend to display more diffuse or irregular changes in arterial structure rather than a localizable mass effect. Severe carotid stenosis usually presents with significant narrowing of the lumen without the notable external contour changes seen in a goblet-like configuration. Carotid artery dissection can lead to a different presentation, typically associated with intimal flaps or other signs of arterial wall damage, rather than the specific shape described in the question.

Thus, the identification of a goblet-like appearance in this context is most consistent with a carotid body tumor, making that the most appropriate conclusion regarding the presented duplex image.