CTICasesPseudo-Pulmonary Embolism due to Bronchial Artery Flow Artifact
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Imaging findings
A CT pulmonary angiogram shows an apparent low-attenuation filling defect in the left lower lobe pulmonary artery, initially interpreted as an acute pulmonary embolism. However, the attenuation of the defect is high and similar to the aorta. The patient has severe, localized bronchiectasis in the left lower lobe with markedly dilated, tortuous bronchial arteries arising from the systemic circulation. A follow-up CT demonstrates a completely patent pulmonary artery without any residual thrombus.
Key takeaways
Dilated systemic bronchial arteries in patients with chronic inflammatory lung diseases like bronchiectasis can create significant systemic-to-pulmonary arterial shunting. Un-opacified or poorly opacified blood rushing retrograde from these high-pressure bronchial arteries into the pulmonary arteries can cause a localized mixing or flow artifact that mimics an acute pulmonary embolism. This 'pseudo-PE' can be recognized by its high Hounsfield unit density, its association with local bronchiectasis, hypertrophied bronchial arteries, and the absence of peripheral vascular occlusion signs.
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