Medical devices in the thoracic cavity

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

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)
bioreactance leads (e.g. Cheetah Starling SV sensors)
breast prostheses
breast tissue expander (used for breast reconstruction)
cooling blanket
presternal peritoneal dialysis catheter

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)

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

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

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)