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, 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 unwary, 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 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
  • all drain holes should be in the pleural cavity to ensure effective 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/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