Intra-aortic balloon pump

Case contributed by Dr Dr Fahad Dilawez Rathore

Presentation

Out of hospital cardiac arrest patient being managed in ITU.

Patient Data

Age: 50 years
Gender: Male
X-ray

Chest x-rays taken on the same day on ITU

Short, vertical, linear radio-opaque marker of an intra-aortic balloon pump seen projected over the AP window in a patient who has had an out of hospital cardiac arrest and was being managed in ITU. Two separate chest radiographs of this same patient where taken on the same day. The first one demonstrated the balloon in the deflated position, and the second demonstrated the balloon inflated (hyperlucency filling the descending thoracic aorta, see annotated image below).  

Other findings in these films include adequately positioned ET tube, right jugular venous line at the brachiocephalic vein/ SVC junction, NG tube with tip and side holes in stomach, ECG lead artefacts and bilateral perihilar thickening. 

Annotated image

Inflated IABP

Annotated image shows normal appearance and position of inflated intra-aortic balloon pump. 

Case Discussion

There are various devices which the radiologist must be able to identify in the intensive care setting. The intra-aortic balloon pump is one of these. When the balloon inflates it will displace blood in the segment of the aorta it comes to occupy both proximally and distally. The balloon is set to dilate during early diastole (immediately after the aortic valve closes) because this is when the maximum amount of blood is available for displacement.  It is important that the balloon is not malpositioned as when it inflates this could cut off circulation to key areas. Therefore the proximal balloon tip must be distal to the take-off of the left subclavian artery and the distal balloon must be proximal to the take-off of the renal arteries. On plain film, if the radio-opaque tip is seen overlying the AP window the balloon is assumed to be correctly positioned. If it does not lie in this window, you should raise the possibility of malpositioning. 

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Case information

rID: 74994
Published: 4th Jun 2020
Last edited: 4th Jun 2020
System: Chest
Inclusion in quiz mode: Included
Institution: University Hospitals of Leicester NHS Trust