CTICasesPulmonary Artery Flow Artifact (Contrast Level) Mimicking Pulmonary Embolism
Imaging findings
CT pulmonary angiogram (CTPA) shows heterogeneous filling of the pulmonary arteries with slow contrast transit and a low amount of contrast reaching the left heart. A "contrast blood level" is visible, where contrast appears layered in the pulmonary artery, and a subsegmental branch shows no opacification, suggesting a pulmonary embolism (PE). Underlying UIP pattern interstitial lung disease contributes to slow flow. Repeat CTPA shows persistent findings. However, a follow-up abdominal/pelvic CT (performed earlier with contrast from the same injection) with thin sections demonstrated full opacification of the previously non-opacified pulmonary artery branch.
Key takeaways
Pulmonary artery flow artifacts, such as contrast-blood levels or transient non-opacification of subsegmental branches, can mimic pulmonary embolism, especially in patients with slow contrast transit due to conditions like heart failure or interstitial lung disease (e.g., UIP). It is crucial to be skeptical of isolated subsegmental filling defects with such artifacts and to look for full opacification on other phases or views if available to avoid unnecessary anticoagulation.
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