CTICasesFlow-related pseudo-pulmonary embolism (black smoke artifact) in scleroderma
Imaging findings
CT pulmonary angiogram shows poor contrast opacification in the lower lobes with filling defects (black smoke artifact) that disappear on adjusting window levels, along with classic NSIP pattern, bronchial artery hypertrophy, and prominent collateral pathways from the abdomen around the esophagus.
Key takeaways
Slow or turbulent pulmonary arterial blood flow, especially in patients with severe lung fibrosis and pulmonary hypertension, can cause pseudo-filling defects resembling acute PE. Recognizing this 'smoke' or flow-related artifact is important to prevent unnecessary anticoagulation.
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