79 yo patient, HTN, smoker, previous PM implantation, atrial fibrillation. Cardiac CT images in arterial (A) and venous (B) phases.
What’s wrong? A – Aortic Aneurysm B – PM lead displacement C – Left atrial appendage thrombus D – Pulmonary embolism
Right answer is C.
CCT has been proposed as an alternative to TEE in excluding the presence of LA and LAA thrombus. Even though CCT has high sensitivity in detecting atrial thrombosis when validated against TEE, false positive findings are common due to slow flow. The use of double phase CCT acquisition with the analysis of late-phase images improves the specificity of the scan in distinguishing sluggish flow from thrombus
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