CTICasesPulmonary Vein Smoke Artifact
Imaging findings
Dual-energy chest CT shows filling defects/layering contrast (smoke) in the right lower lobe pulmonary vein, downstream of a severe acute pulmonary embolism in the right lower lobe pulmonary artery. Abdominal CT venous phase shows the vein is patent.
Key takeaways
Upstream obstruction of a pulmonary artery by an embolus causes slow blood flow through the capillary bed and the downstream pulmonary vein. This slow flow can cause contrast pooling ('smoke' or stasis artifact) in the pulmonary vein, mimicking venous thrombosis.
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