CTICasesPenetrating atherosclerotic ulcer
Imaging findings
Contrast-enhanced CT shows high-attenuation hemopericardium with IVC reflux and flow artifact/smoke in the aortic arch mimicking dissection. Surgical exploration revealed a small clotted hemopericardium and a penetrating atherosclerotic ulcer under the aortic arch without dissection.
Key takeaways
Aortic flow artifacts on CT can mimic acute aortic dissection, especially in low-output states. A high-attenuation hemopericardium indicates a real source of hemorrhage, such as a ruptured penetrating atherosclerotic ulcer.
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