Medical devices in the thorax
Medical devices in the thorax are regularly observed by radiologists when reviewing radiographs and CTs.
On this page:
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
Related Radiopaedia articles
Chest
- imaging techniques
-
chest x-ray
-
approach
- adult
- pediatric
- neonatal
-
airspace opacification
- differential diagnoses of airspace opacification
- lobar consolidation
-
atelectasis
- mechanism-based
- morphology-based
- lobar lung collapse
- chest x-ray in the exam setting
- cardiomediastinal contour
- chest radiograph zones
- tracheal air column
- fissures
- normal chest x-ray appearance of the diaphragm
- nipple shadow
-
lines and stripes
- anterior junction line
- posterior junction line
- right paratracheal stripe
- left paratracheal stripe
- posterior tracheal stripe/tracheo-esophageal stripe
- posterior wall of bronchus intermedius
- right paraspinal line
- left paraspinal line
- aortic-pulmonary stripe
- aortopulmonary window
- azygo-esophageal recess
- spaces
- signs
- air bronchogram
- big rib sign
- Chang sign
- Chen sign
- coin lesion
- continuous diaphragm sign
- dense hilum sign
- double contour sign
- egg-on-a-string sign
- extrapleural sign
- finger in glove sign
- flat waist sign
- Fleischner sign
- ginkgo leaf sign
- Golden S sign
- Hampton hump
- haystack sign
- hilum convergence sign
- hilum overlay sign
- Hoffman-Rigler sign
- holly leaf sign
- incomplete border sign
- juxtaphrenic peak sign
- Kirklin sign
- medial stripe sign
- melting ice cube sign
- more black sign
- Naclerio V sign
- Palla sign
- pericardial fat tag sign
- Shmoo sign
- silhouette sign
- snowman sign
- spinnaker sign
- steeple sign
- straight left heart border sign
- third mogul sign
- tram-track sign
- walking man sign
- water bottle sign
- wave sign
- Westermark sign
-
approach
- HRCT
-
chest x-ray
- airways
- bronchitis
- small airways disease
-
bronchiectasis
- broncho-arterial ratio
- related conditions
- differentials by distribution
- narrowing
-
tracheal stenosis
- diffuse tracheal narrowing (differential)
-
bronchial stenosis
- diffuse airway narrowing (differential)
-
tracheal stenosis
- diverticula
- pulmonary edema
-
interstitial lung disease (ILD)
- drug-induced interstitial lung disease
-
hypersensitivity pneumonitis
- acute hypersensitivity pneumonitis
- subacute hypersensitivity pneumonitis
- chronic hypersensitivity pneumonitis
- etiology
- bird fancier's lung: pigeon fancier's lung
- farmer's lung
- cheese workers' lung
- bagassosis
- mushroom worker’s lung
- malt worker’s lung
- maple bark disease
- hot tub lung
- wine maker’s lung
- woodsman’s disease
- thatched roof lung
- tobacco grower’s lung
- potato riddler’s lung
- summer-type pneumonitis
- dry rot lung
- machine operator’s lung
- humidifier lung
- shower curtain disease
- furrier’s lung
- miller’s lung
- lycoperdonosis
- saxophone lung
-
idiopathic interstitial pneumonia (mnemonic)
- acute interstitial pneumonia (AIP)
- cryptogenic organizing pneumonia (COP)
- desquamative interstitial pneumonia (DIP)
- non-specific interstitial pneumonia (NSIP)
- idiopathic pleuroparenchymal fibroelastosis
- lymphoid interstitial pneumonia (LIP)
- respiratory bronchiolitis–associated interstitial lung disease (RB-ILD)
- usual interstitial pneumonia / idiopathic pulmonary fibrosis (UIP/IPF)
-
pneumoconioses
- fibrotic
- non-fibrotic
-
lung cancer
-
non-small-cell lung cancer
-
adenocarcinoma
- pre-invasive tumors
- minimally invasive tumors
- invasive tumors
- variants of invasive carcinoma
- described imaging features
- adenosquamous carcinoma
- large cell carcinoma
- primary sarcomatoid carcinoma of the lung
- squamous cell carcinoma
- salivary gland-type tumors
-
adenocarcinoma
- pulmonary neuroendocrine tumors
- preinvasive lesions
-
lung cancer invasion patterns
- tumor spread through air spaces (STAS)
- presence of non-lepidic patterns such as acinar, papillary, solid, or micropapillary
- myofibroblastic stroma associated with invasive tumor cells
- pleural invasion
- vascular invasion
- tumors by location
- benign neoplasms
- pulmonary metastases
- lung cancer screening
- lung cancer staging
-
non-small-cell lung cancer