CTICasesAortic Contrast-Fluid Level
Imaging findings
Contrast-enhanced chest CT in a patient on ECMO support for massive pulmonary embolism shows a prominent, horizontal contrast-fluid level (contrast layering) in the descending thoracic aorta on early phase images, which disappears on delayed 90-second images. Markedly dilated right chambers are present.
Key takeaways
Contrast-fluid layering or level in the aorta is an imaging artifact seen in patients with severely reduced cardiac output (such as during cardiogenic shock or ECMO). Because contrast is denser than blood, it pools and layers in the dependent portion of the aorta rather than mixing, mimicking an aortic thrombus. The disappearance of the level on delayed scans confirms the artifact.
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