Medical devices in the thorax

Medical devices in the thorax are regularly observed by radiologists when reviewing radiographs and CT scans.

Extrathoracic devices

• tubing, clamps, syringes, scissors, lying on or under the patient

• rubber sheets, foam mattresses, clothing, hair braids, nipple piercings, etc., may also be visible

These devices are a common cause of artifacts and may trip the unweary, but in general, are recognized for what they are.

The following are more important to be recognized by the radiologist:

• oxygen masks and ventilator support tubing 

• temperature and humidity sensor attachments

• ECG electrodes/leads

• external pacemaker-defibrillator (typically seen in a cardiac patient transported by helicopter or ambulance) ¹

• bioreactance leads (e.g. Cheetah Starling SV sensors)

• breast prostheses

• breast tissue expander (used for breast reconstruction)

• cooling blanket

• presternal peritoneal dialysis catheter

Pleural devices

• thoracostomy tubes

  • usually placed anterosuperiorly to drain pneumothorax, and posteroinferiorly to drain pleural effusion

  • a well-positioned tube should lie between the visceral and parietal pleura, and there should not be any kinking

  • to check the correct positioning, frequently AP and lateral views are required. A supplemental CT scan may also be performed.

  • should not enter the interlobar fissure, else it may be blocked ¹; tip should not be within the lung parenchyma or subcutaneous tissue

  • all drain holes should be in the pleural cavity to ensure adequate drainage ⁵

• pigtail catheter: used in empyema drainage

• Heimlich valve: it is a one-way valve used for pleural space drainages, which prevents the return of gases or fluids into the pleural space

• plombage: "ping-pong ball" plombage and wax plombage (historically used for tuberculosis, but no longer)

Tracheal, bronchial and esophageal devices

• endotracheal tube

  • tip of the tube should be 5 cm +/- 2 cm above the carina ² (carina is just caudad to the aortic arch, if not clearly visible)

  • may wrongly enter right main bronchus, esophagus or even the soft tissues of the neck

  • sometimes, a deliberate double-lumen ET tube is used to check differential ventilation of the two lungs ¹

• nasogastric/nasoenteric tube

  • ​Dobhoff tube

• esophageal balloon tamponade device 

• esophageal Doppler probe

• esophageal stents

• esophageal manometer

• esophageal pH probe (seen just above gastro-esophageal junction)

• temperature probe (usually within the oropharynx or esophagus)

• tracheostomy tube

  • Passy-Muir speaking valve

• tracheo-esophageal voice prosthesis

• bronchial stents / tracheobronchial stents (in lung transplant patients or due to obstructing tumors)

• ​endobronchial coils

• endobronchial valves

Vascular devices

• dialysis catheters

• peripherally inserted central catheters (PICC): central portion only

• central venous catheters: central tip ideally positioned at the superior cavoatrial junction and should not enter the right atrium 

  • temporary non-tunneled lines: internal jugular and subclavian lines

  • tunneled lines: e.g. Hickman line, Broviac line

  • permanent, implantable access line with subcutaneous ports: e.g. Port-A-Cath, Infus-a-Port

• pulmonary artery catheter (Swan-Ganz catheter)

• left atrial catheter

• right atrial line often used postpaediatric cardiac surgery

• thoracic aortic stent

• superior vena caval stent

• superior vena caval filter

• carotid artery clamps

• cannulas of extracorporeal membrane oxygenation devices

  • in the right jugular vein (in case of peripheral cannulation), rarely in the left jugular vein

  • in case of central cannulation, both cannulas are placed directly via central vessels into the atria

Cardiac devices

• sternal wires, plates

• cardiac prosthetic valves, C-ring annuloplasty

• cardiac conduction devices

  • pacemakers (e.g. biventricular pacemaker)

  • implantable cardiac defibrillators (ICD)

  • temporary pacing wires (TPW)

• coronary stents

• circulatory assist devices

  • intra-aortic balloon pump (IABP)

  • left ventricular assist device (LVAD) (e.g. TandemHeart percutaneous VAD)

  • biventricular assist devices

  • artificial heart (under development)

  • temporary ventricular assist device

• atrial septal occlusion device (e.g. Amplatz closure device)

• left atrial appendage closure devices (e.g. Watchman device)

• epicardial patch

• parachute device

• cardiac restraint device

• insertable cardiac monitoring device (e.g. Reveal LINQ)

• implantable pulmonary artery pressure monitoring device (e.g. CardioMEMS)

Miscellaneous

• embolization coils

• antibiotic spacer

• pericardial drain

• insertable loop recorder

• vertebroplasty-related

• spinal rods, transpedicular screws, disc spacers, interspinous spacers

• gastric band

• reflux management system

• diaphragmatic pacemaker

• surgical clips (e.g. axillary nodal clearance)

• surgical chest bars

  • Nuss bar (repair of pectus excavatum)

  • Ravitch procedure

See also

• ​cardiac conduction devices

• medical devices in the head and neck

• medical devices in the abdomen and pelvis

• medical devices in the limbs