CTICasesAortic Flow mixing (Smoke) Artifact
Imaging findings
Contrast-enhanced CT angiogram shows a prominent, horizontal, low-attenuation band of poor contrast mixing (or "smoke" artifact) in the transverse aortic arch and proximal descending thoracic aorta. A repeat CT angiogram obtained with a slightly delayed arterial phase demonstrates complete resolution of the low-attenuation band with normal, homogeneous opacification of the aorta.
Key takeaways
Slower blood flow along the inner curvature (undersurface) of the aortic arch can cause transient contrast-mixing artifacts that mimic acute aortic dissection on early-phase, rapid-pitch helical acquisitions. This phenomenon of slower flow also explains why aortic thrombi preferentially develop in this specific location.
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