CTICasesFlow-Related Pseudo-Embolus (Smoke Artifact) in Idiopathic Pulmonary Fibrosis
Imaging findings
In an older patient with idiopathic pulmonary fibrosis and extensive basal-predominant honeycombing and traction bronchiectasis, a single area of amorphous, ill-defined increased attenuation is seen within a mildly dilated vessel in the most fibrotic region of the left upper lobe, measuring around 180 Hounsfield units, too dense to represent a true thrombus, and not conspicuous on angiographic windows.
Key takeaways
This is an isolated slow-flow mixing, or smoke, artifact occurring within a dilated vessel in an area of severe fibrosis, likely related to sluggish flow from a limited or asymmetric contrast bolus reaching a small, distorted vascular bed rather than a true embolus. Recognizing the amorphous margins and appropriate attenuation helps avoid a false diagnosis of pulmonary embolism in fibrotic lung.
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