Typical but uncommon computed tomography angiographic appearance of left ventricular assist device: Awareness is key!

Left ventricular assist devices (LVAD) are now a standard of care for patients awaiting heart transplant. Our patient had undergone placement of the HeartWare LVAD and presented to the hospital with complaints of fatigue, dyspnea, fever and discharge from the LVAD site. She underwent computed tomography angiography (CTA) to evaluate the LVAD. CTA revealed a hypodense area surrounding the outflow graft throughout its extent. This was suspicious of a thrombus. The repeat CTA performed 4 days later did not show any change in appearance of the outflow graft. This appearance was in fact due to the co-axial relationship of the two outflow grafts creating a potential space between them that can be filled with blood. This is a normal appearance and should not be mistaken for a thrombus. The awareness of the normal imaging appearance of the LVAD devices is essential to avoid unnecessary surgical intervention.