CTICasesContrast Mixing Artifact
Imaging findings
Chest CT in a patient post treatment for lung cancer shows slow flow and contrast mixing artifacts (contrast smoke or transient filling defects) within the left atrium and left atrial appendage. Contrast-enhanced CT reveals chronic occlusion of the left upper lobe pulmonary vein due to prior radiation/chemotherapy, which halts flow and causes blood stagnation.
Key takeaways
Contrast mixing artifacts in the left atrium are a common benign pitfall on chest CT. They occur when unopacified blood from one pulmonary vein mixes with contrast-opacified blood from other veins, mimicking a left atrial thrombus. Radiation-induced pulmonary vein occlusion or stenosis can cause localized stagnation of flow, magnifying this mixing artifact.
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