Medical devices in the thorax

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

Extrathoracic devices

• tubing, clamps, syringes lying on or under the patient
• rubber sheets, foam mattresses, clothing, hair braids, nipple piercings etc. may also be visible

These devices are mostly unimportant for imaging purposes.  

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

• 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
• 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 visceral and parietal pleura, and there should not be any kinking
  • to check the correct positioning, frequently AP and lateral views are required. 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
• 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/feeding tube / Dobhoff tube
• esophageal balloons (e.g. Sengstaken-Blakemore tube, Minnesota tube)
• 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
• tracheo-esophageal voice prosthesis
• bronchial stents / tracheobronchial stents (in lung transplant patients or due to obstructing tumors)
• Passy-Muir valve
• 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-tunnelled lines: internal jugular and subclavian lines
  • tunnelled 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)
• 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)
• Nuss bar (repair of pectus excavatum)

See also

• medical devices of abdomen and pelvis
• medical devices of the neck
• cardiac conduction devices