Medical devices in the thorax

Medical devices in the thoracic cavity are regularly observed by radiologists on plain film and CT reporting. While many devices are easily understood and seen commonly like central venous catheter, Ryle's tube etc., many new devices are being introduced everyday. It i also important to know their correct positioning.

Extra-thoracic devices

• tubings, clamps, syringes lying on or under the patient.
• rubber sheets, foam mattresses or similar paraphernalia may also be visible on chest radiographs

Above mentioned devices are mostly unimportant for imaging purpose, but they still need to be recognised by the radiologist.

• ventilator support tubing
• temparature and humidity sensor attachments
• ECG electrodes
• external pacemaker-defibrillator (typically seen in cardiac patient transported by helicopter or ambulance)¹
• breast prostheses
• breast tissue expander (used for breast reconstruction)

Pleural devices

• thoracostomy tubes - they are usually placed anterosuperiorly to drain pneumothorax, and posteroinferiorly to drain pleural effusion. Normal positioned tube lie between visceral and parietal pleura, and there should not be any kinking. To check the correct positioning, frequently AP and Lateral views are required. CT scan may also be supplemented. Chest tubes should not enter the interlobar fissure, else it may be blocked¹. Also, its tip should not be within the lung parenchyma or subcutaneous tissue
• pigtail catheter - used in empyema drainage
• plombage - "ping-pong" ball plombage and wax plombage (was used for tuberculosis, not used now-a-days)

Tracheal and oesophageal devices

• endotracheal tube - tip of the tube should be 5 cm + / - 2cm ² above carina (carina is just caudad to aortic arch, if not clearly visible). This tube also may wrongly enter right main bronchus, oesophagus or even the soft tissues of neck. Sometimes, a deliberate double-lumen ET tube is used to check differential ventilation of two lungs¹ 
• nasogastric tube / feeding tube
• esophageal balloons
• esophageal stents
• pH probe (seen just above GE junction)
• tracheostomy tube
• tracheo-esophageal voice prosthesis
• bronchial stents / tracheobroncial stents (in lung transplant patients or due to obstructing tumours)

Vascular devices

• dialysis catheters
• central venous cathete - ideally positioned in SVC, and should not enter right atrium
  • internal jugular line
  • infraclavicular line
  • tunnelled lines, e.g. Hickman line, Broviac line
  • implantable access line with subcutaneous ports, e.g. Port-A-Cath
• Swan-Ganz catheter (pulmonary artery catheter)
• left atrial catheter
• direct right atrial line - often used post paediatric cardiac surgery
• thoracic aortic stent

Cardiac devices

• sternal wires
• cardiac prosthetic valves
• pacemakers
• coronary stents
• circulatory assist devices
  • intra-aortic balloon pump (IABP)
  • left ventricular assist devices like 'Tandemheart'
  • biventricular assist devices
  • artificial heart (being developed!)
• ASD closure device
• atrial appendage occluder devices
• implantable cardiac defibrillators (ICD)

Miscellaneous

• embolization coils
• remote telemetry ECG monitoring device
• pericardial drain
• insertable loop recorder
• vertebroplasty related
• gastric band

See also

• medical devices of abdomen and pelvis
• cardiac pacemakers