CTICasesAortic flow artifact (smoke finding) mimicking type B aortic dissection
Imaging findings
CT angiogram shows a wispy, low-density filling defect along the lesser curvature of the aortic arch and descending aorta. The patient had chronic/acute pulmonary embolism with severe RV strain, causing underfilling of the left heart and sluggish aortic flow, while the intimal calcification remained intact.
Key takeaways
Sluggish blood flow (smoke finding), particularly in the setting of severe pulmonary embolism or low cardiac output, can mimic a type B aortic dissection on CT. Preserved intimal calcification and a lesser-curvature distribution of the artifact help differentiate it from a true dissection.
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