medical devices in the thorax

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

Extrathoracic devices

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)
  • 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 ; tip should not be within the lung parenchyma or subcutaneous tissue
    • all drain holes should be in the pleural cavity to ensure effective drainage
  • 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 (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
  • 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

Cardiac devices

Miscellaneous

See also