CTICasesAortic Flow Artifact ("Smoke") Mimicking Intraluminal Thrombus or Dissection
Imaging findings
On a neck CTA obtained for suspected dissection, an ill-defined, smoky, wispy filling defect is seen along the descending thoracic aorta; on repeat CTA the following day the finding persists but appears different in configuration and location. A subsequently obtained delayed-phase acquisition shows complete resolution of the finding.
Key takeaways
An ill-defined, smoky filling defect in the aorta that changes appearance between studies and resolves entirely on delayed imaging represents slow-flow artifact rather than thrombus or dissection, exaggerated here by a reduced ejection fraction (30-35%) causing sluggish flow; delayed-phase imaging rather than intervention is the appropriate next step when this artifact is suspected.
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