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Gallery of Medical Devices

Part 2: Devices of the Head, Neck, Spine, Chest, and Abdomen¹

¹ From the Department of Radiology, University of Arizona Health Sciences Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067. Received March 15, 2005; revision requested March 16 and received March 31; accepted April 4. All authors have no financial relationships to disclose. Address correspondence to M.S.T. (e-mail: mihrat{at}radiology.arizona.edu).

This gallery of medical devices illustrates a multitude of common devices in the head, neck, spine, chest, and abdomen that are found in daily radiologic practice (orthopedic devices for the extremities and pelvis were illustrated in Part 1 [1]). All these medical devices have been more thoroughly discussed in the previous articles in this medical devices series and in other detailed references (1–6). The present article is a comprehensive overview of these devices and provides a quick reference for identifying an unfamiliar device (2). It is intended to allow the reader to identify a device generically and to understand its purpose. It is important to recognize the presence of a device, understand its purpose and proper function, and recognize the complications associated with its use. Knowing the specific or proper brand name of every device is not important and frequently not possible. New devices are constantly being introduced, although most of them are variations of a previous device. Sometimes, so many devices are used in a patient’s treatment that they obscure important anatomy and pathologic conditions (Fig 1).

View larger version (178K): [in this window] [in a new window]   Figure 1.  Numerous extrathoracic and intrathoracic devices. Anteroposterior portable radiograph of the chest shows bilateral chest drains, an endotracheal tube, left jugular catheter, median sternotomy wires, external defibrillator connectors, and electrocardiographic leads in and overlying the patient’s chest. The profusion of devices makes the radiograph uninterpretable.

View larger version (139K): [in this window] [in a new window]   Figure 2.  Aneurysm clip. Lateral radiograph of the skull shows a metallic clip (arrow), which was placed to treat a ruptured left anterior cerebral artery aneurysm, that projects over the skull base. Note the craniotomy defect attached to the calvaria by surgical clips and a programmable cerebrospinal fluid shunt.

View larger version (131K): [in this window] [in a new window]   Figure 3a.  Cranial traction tongs and halo device. Anteroposterior (a) and lateral (b) radiographs of the head and neck show cranial traction tongs and a halo device that overlie the patient’s head, neck, and upper thorax and that stabilize a cervical spine fracture. Endotracheal and nasogastric tubes are also present.

View larger version (131K): [in this window] [in a new window]   Figure 3b.  Cranial traction tongs and halo device. Anteroposterior (a) and lateral (b) radiographs of the head and neck show cranial traction tongs and a halo device that overlie the patient’s head, neck, and upper thorax and that stabilize a cervical spine fracture. Endotracheal and nasogastric tubes are also present.

View larger version (107K): [in this window] [in a new window]   Figure 4a.  Deep brain stimulators. Anteroposterior (a) and lateral (b) radiographs of the skull show bilateral deep brain stimulators placed into the thalamus to treat Parkinson disease.

View larger version (149K): [in this window] [in a new window]   Figure 4b.  Deep brain stimulators. Anteroposterior (a) and lateral (b) radiographs of the skull show bilateral deep brain stimulators placed into the thalamus to treat Parkinson disease.

View larger version (131K): [in this window] [in a new window]   Figure 5.  Anterior cervical spine fusion. Lateral radiograph of the cervical spine shows anterior cervical fusion and diskectomy of the C2–C5 vertebral bodies with a plate and screw device (Danek; Medtronic Sofamor Danek, Memphis, Tenn), as well as C3–C4 corpectomy with a titanium cage device (Pyramesh, Medtronic Sofamor Danek). The cage device is filled with bone allograft. The devices were used to treat severe cervical spine stenosis and cord decompression.

View larger version (128K): [in this window] [in a new window]   Figure 6.  Cervical spine laminoplasty (7) and posterior cervical fusion. Anteroposterior radiograph of the cervical spine shows C3–C7 laminoplasty (hinge elevation of the lamina from the dorsum of the cervical cord) and C6-T1 posterior spinal fusion with lateral mass plates and iliac crest bone graft. Laminectomy defects are present at the C3–C7 levels. Note the anchor screws placed into the pedicles at the laminoplasty levels (arrows) and bilateral Danek lateral mass plate and screw devices (Medtronic Sofamor Danek) at the C6-T1 levels. A drain overlying the upper cervical spine is also seen.

View larger version (105K): [in this window] [in a new window]   Figure 7a.  Posterior spinal fusion. Anteroposterior (a) and lateral (b) radiographs of the lumbar spine show posterior spinal fusion of L4-S1 with a pedicle-screw fixation spinal system with two transverse connectors (Moss Miami system polyaxial screws; DePuy AcroMed, Raynham, Mass). In addition, metallic cage devices (BAK; Zimmer Spine, Minneapolis, Minn) are placed at the L4–5 disk space level, right back to front/correct (arrowhead) and left front to back/upside down (arrow).

View larger version (91K): [in this window] [in a new window]   Figure 7b.  Posterior spinal fusion. Anteroposterior (a) and lateral (b) radiographs of the lumbar spine show posterior spinal fusion of L4-S1 with a pedicle-screw fixation spinal system with two transverse connectors (Moss Miami system polyaxial screws; DePuy AcroMed, Raynham, Mass). In addition, metallic cage devices (BAK; Zimmer Spine, Minneapolis, Minn) are placed at the L4–5 disk space level, right back to front/correct (arrowhead) and left front to back/upside down (arrow).

View larger version (135K): [in this window] [in a new window]   Figure 8.  Vertebroplasty. Anteroposterior radiograph of the upper lumbar spine shows methyl methacrylate that was placed in an upper lumbar vertebra for vertebroplasty treatment of an osteoporotic fracture. Methyl methacrylate mixed with barium is injected into the vertebral body (8).

View larger version (158K): [in this window] [in a new window]   Figure 9.  Sacral nerve stimulator. Anteroposterior radiograph of the pelvis shows a sacral nerve stimulator that overlies the right sacral side and is connected to an implantable generator. The latter overlies the right lower abdomen and iliac crest.

View larger version (175K): [in this window] [in a new window]   Figure 10.  Mechanical prosthetic heart valve. Anteroposterior radiograph of the chest shows a metallic prosthetic aortic heart valve (Carbomedics, Austin, Tex) (open arrow), as well as an intraaortic balloon pump catheter (black arrow), a Swan-Ganz catheter (*), bilateral chest drains (white straight arrows), a nasogastric tube (curved arrows), an endotracheal tube (black arrowhead), and a right jugular catheter (white arrowhead).

View larger version (159K): [in this window] [in a new window]   Figure 11.  Intraaortic balloon pump catheter and Swan-Ganz catheter. Anteroposterior radiograph of the chest shows an intraaortic balloon pump catheter (curved arrow), a Swan-Ganz catheter (white straight arrow), an endotracheal tube (black arrow), a mediastinal drain (arrowhead), electrocardiographic leads, and a nasogastric tube.

View larger version (156K): [in this window] [in a new window]   Figure 12a.  Three-lead pacemaker and biomechanical prosthetic mitral heart valve. Posteroanterior (a) and lateral (b) radiographs of the chest show a three-lead pacemaker (Carbomedics) placed via the left subclavian vein with the electrodes in the right ventricle (lower arrow), in the right atrium (upper arrow), and in the right superior vena cava–right atrial junction (not marked). A biomechanical prosthetic mitral heart valve is also seen.

View larger version (142K): [in this window] [in a new window]   Figure 12b.  Three-lead pacemaker and biomechanical prosthetic mitral heart valve. Posteroanterior (a) and lateral (b) radiographs of the chest show a three-lead pacemaker (Carbomedics) placed via the left subclavian vein with the electrodes in the right ventricle (lower arrow), in the right atrium (upper arrow), and in the right superior vena cava–right atrial junction (not marked). A biomechanical prosthetic mitral heart valve is also seen.

View larger version (177K): [in this window] [in a new window]   Figure 13a.  Biventricular pacemaker. Posteroanterior (a) and lateral (b) radiographs of the chest show a biventricular pacemaker placed via the right subclavian vein with one electrode in the right ventricle (arrow) and a second electrode in the coronary sinus–draining vein from the left ventricle (arrowhead). The device paces both cardiac ventricles simultaneously.

View larger version (157K): [in this window] [in a new window]   Figure 13b.  Biventricular pacemaker. Posteroanterior (a) and lateral (b) radiographs of the chest show a biventricular pacemaker placed via the right subclavian vein with one electrode in the right ventricle (arrow) and a second electrode in the coronary sinus–draining vein from the left ventricle (arrowhead). The device paces both cardiac ventricles simultaneously.

View larger version (153K): [in this window] [in a new window]   Figure 14.  Implantable cardioverter defibrillator. Anteroposterior radiograph of the chest shows an implantable cardioverter defibrillator device (Medtronic, Minneapolis, Minn) placed via the left subclavian vein with the proximal electrode in the superior vena cava and the distal electrode in the right ventricle.

View larger version (124K): [in this window] [in a new window]   Figure 15.  Biventricular assist device. Anteroposterior radiograph of the abdomen shows a cardiac biventricular assist device (BVS-5000; Abiomed, Danvers, Mass) in a patient with end-stage heart failure. The assist device is used as a bridge to cardiac transplantation.

View larger version (123K): [in this window] [in a new window]   Figure 16a.  Biventricular assist device. Anteroposterior (a) and cross-table lateral (b) radiographs of the chest show a biventricular assist device (Medos, Aachen, Germany) (*) in a patient with end-stage heart failure. The assist device is used as a bridge to cardiac transplantation. Note the endotracheal and feeding tubes.

View larger version (110K): [in this window] [in a new window]   Figure 16b.  Biventricular assist device. Anteroposterior (a) and cross-table lateral (b) radiographs of the chest show a biventricular assist device (Medos, Aachen, Germany) (*) in a patient with end-stage heart failure. The assist device is used as a bridge to cardiac transplantation. Note the endotracheal and feeding tubes.

View larger version (138K): [in this window] [in a new window]   Figure 17a.  Artificial heart. Anteroposterior (a) and lateral (b) radiographs of the chest show a total artificial heart (CardioWest; SynCardia Systems, Tucson, Ariz) that serves as a bridge to cardiac transplantation).

View larger version (142K): [in this window] [in a new window]   Figure 17b.  Artificial heart. Anteroposterior (a) and lateral (b) radiographs of the chest show a total artificial heart (CardioWest; SynCardia Systems, Tucson, Ariz) that serves as a bridge to cardiac transplantation).

View larger version (174K): [in this window] [in a new window]   Figure 18.  Atrial septal closure device. Lateral radiograph of the chest shows an atrial septal closure device (Sideris; AGA Medical, Golden Valley, Minn) (arrow).

View larger version (146K): [in this window] [in a new window]   Figure 19.  Mechanical and biologic heart valves. Lateral radiograph of the chest shows a mechanical mitral valve (Carbomedics) (curved arrow), a mechanical aortic valve (Top-hat; Carbomedics) (arrowhead), and a biologic tricuspid valve (Hancock; Medtronic) (straight arrow). Note the sternotomy wires, epicardial pacing wire, and mediastinal clips.

View larger version (130K): [in this window] [in a new window]   Figure 20.  Tracheal stent. Anteroposterior radiograph of the chest shows a tracheal stent (Dumon silicone stent; Cometh, Marseille, France) (arrows) placed for tracheal expansion in a patient with tracheal stenosis.

View larger version (163K): [in this window] [in a new window]   Figure 21.  Pigtail catheter. Anteroposterior radiograph of the chest shows a 10-F pigtail catheter (Abscession general drainage catheter; AngioDynamics, Queensbury, NY) placed into the right pleural space for drainage in a patient with empyema.

View larger version (131K): [in this window] [in a new window]   Figure 22.  Implantable loop recorder. Anteroposterior collimated radiograph of the upper abdomen shows an implantable loop recorder (Medtronic) in the left breast of a female patient. The recorder is used for prolonged monitoring of cardiac rhythm.

View larger version (136K): [in this window] [in a new window]   Figure 23.  Chest port. Magnified fluoroscopic anteroposterior radiograph of the upper chest shows a subcutaneous chest port (8-F Vaxcel single-lumen chest port; Boston Scientific, Natick, Mass) with the catheter placed in the right internal jugular vein. The catheter tip is in the superior vena cava at the right atrial junction.

View larger version (142K): [in this window] [in a new window]   Figure 24.  Chest drains and epicardial pacing wires. Anteroposterior radiograph of the chest shows bilateral chest drains (straight arrows), a feeding tube (curved arrow), and a test tube containing epicardial pacing wires (arrowhead). Note also an endotracheal tube and electrocardiographic leads.

View larger version (147K): [in this window] [in a new window]   Figure 25.  Extracorporeal membrane oxygenation. Anteroposterior radiograph of the chest of a neonate undergoing extracorporeal membrane oxygenation shows bilateral pulmonary edema, a cannula in the right jugular vein (curved arrow) with its tip in the right atrium and a second cannula in the right carotid artery (straight arrow). The jugular cannula is connected to tubing (*), and the carotid cannula is connected to another tube (arrowhead). Both tubes are connected to a centrifugal pump and oxygenator (not shown). An endotracheal tube, nasogastric tube, umbilical venous catheter, and electrocardiographic leads are also seen.

View larger version (140K): [in this window] [in a new window]   Figure 26.  Tracheostomy tube. Anteroposterior radiograph of the chest shows a tracheostomy tube (arrow). Note the bilateral chest tubes or drains, a feeding tube, and a peripherally inserted venous catheter in the left subclavian vein with its tip in the distal superior vena cava.

View larger version (84K): [in this window] [in a new window]   Figure 27.  Umbilical arterial and umbilical venous catheters. Cross-table lateral radiograph of the abdomen shows an umbilical arterial catheter (arrow) and umbilical venous catheter (arrowhead) in a neonate. Ideally, an umbilical venous catheter should be positioned in the right atrium (just above the diaphragm) and an umbilical arterial catheter between T6 and T10 (high position) or between L3 and L5 (low position) (9).

View larger version (149K): [in this window] [in a new window]   Figure 28.  Gastroschisis bag. Anteroposterior radiograph of the abdomen shows a gastroschisis bag (arrows).

View larger version (115K): [in this window] [in a new window]   Figure 29.  Gastrostomy tube. Anteroposterior radiograph of the abdomen shows a percutaneous gastrostomy tube (Mic-Key low-profile feeding tube; Kimberly-Clark, Roswell, Ga) that has been injected with contrast material.

View larger version (157K): [in this window] [in a new window]   Figure 30.  Surgical drain, feeding tube, embolization coils. Anteroposterior radiograph of the abdomen shows a surgical drain (Silicone Jackson Pratt–style flat drain; C. Daniel Medical, Atlanta, Ga) in the pelvis (arrow). In the upper abdomen, there is an oral feeding tube (10-F enteral feeding tube; Viasys Healthcare, Wheeling, Ill) and poorly seen embolization microcoils (Tornado, Bloomington, Ind) in the epigastric region from a prior embolization of an upper gastrointestinal hemorrhage.

View larger version (127K): [in this window] [in a new window]   Figure 31.  Feeding tube and ureteral stents. Antero-posterior radiograph of the abdomen, obtained with the patient supine, demonstrates an oral nasogastric feeding tube (Corflo; Viasys Healthcare) with the distal tip (white arrow) in the terminal portion of the duodenum. Bilateral double-J ureteral stents (Percuflex; Boston Scientific) (black arrows) are also seen.

View larger version (134K): [in this window] [in a new window]   Figure 32.  Gastrojejunostomy and nasogastric feeding tubes. Anteroposterior radiograph of the abdomen shows a 14-F percutaneous gastrojejunostomy feeding tube (Shetty tube; Cook, Bloomington, Ind) (white arrow) with the distal tip near the ligament of Trietz and a nasogastric feeding tube (Corflo; Viasys Health-care) with the distal tip in the stomach (black arrow).

View larger version (144K): [in this window] [in a new window]   Figure 33.  Ureteral stent in a kidney transplant. Sonogram of a transplanted kidney shows an 8.5-F, 12-cm double-J ureteral stent (Ultrathane Amplatz; Cook).

View larger version (118K): [in this window] [in a new window]   Figure 34.  Nephrostomy catheter. Fluoroscopic image shows an 8-F percutaneous nephrostomy tube after injection of contrast material (Flexima locking loop nephrostomy catheter; Boston Scientific).

View larger version (130K): [in this window] [in a new window]   Figure 35.  Suprapubic catheter and embolization coils. Magnified anteroposterior radiograph of the pelvis shows a suprapubic catheter (16-F Foley catheter; Bard Medical, Covington, Ga) (white arrow) and coils (Complex Helical Platinum Coils; Boston Scientific and Target Vascular, Fremont, Calif) (black arrow) from pelvic embolization.

View larger version (130K): [in this window] [in a new window]   Figure 36.  Radioactive seed implants. Anteroposterior radiograph of the pelvis shows radioactive seed implants placed into the prostate gland for treatment of prostate carcinoma.

View larger version (109K): [in this window] [in a new window]   Figure 37.  Penile prosthesis. Anteroposterior radiograph of the pelvis demonstrates a prosthetic penile implant (Alpha I; Mentor, Santa Barbara, Calif). Note the left total hip arthroplasty.

View larger version (170K): [in this window] [in a new window]   Figure 38.  Tubal ligation clips. Anteroposterior radiograph of the pelvis shows tubal ligation clips (Filshie; Avalon Medical, Lake Forest, Calif) (arrows).

View larger version (141K): [in this window] [in a new window]   Figure 39.  Tandem and ovoids. Anteroposterior radiograph of the pelvis shows a tandem (arrowhead) placed in the uterine cervix and ovoids (arrows) placed in the vagina for intracavitary brachytherapy treatment of cervical carcinoma.

View larger version (137K): [in this window] [in a new window]   Figure 40.  Pessary. Anteroposterior radiograph of the pelvis shows a pessary (Donut; Milex Products, Chicago, Ill) placed in the vagina to support the uterus and prevent uterine prolapse.

View larger version (130K): [in this window] [in a new window]   Figure 41.  Intrauterine device and Foley catheter. Anteroposterior radiograph of the pelvis shows an intrauterine device (ParaGard T380A; FEI Women’s Health, New York, NY) (black arrow), a Foley catheter (white arrow), and multiple orthopedic devices that transfix pelvic fractures. A partially threaded cancellous cannulated screw with a washer transfixes the left sacroiliac joint, and a reconstruction plate with four screws transfixes the symphysis pubis. Note the skin staples.

View larger version (97K): [in this window] [in a new window]   Figure 42.  Intrauterine device. Axial computed tomographic image of the pelvis shows an intrauterine device (ParaGard T380A; FEI Women’s Health) (arrow).

View larger version (140K): [in this window] [in a new window]   Figure 43.  Abdominal aortic stent graft. Anteroposterior radiograph of the abdomen, obtained with the patient supine, shows an abdominal aortic stent graft (AneuRx; Medtronic) (arrow).

View larger version (168K): [in this window] [in a new window]   Figure 44.  Vascular venous stent. Fluoroscopic radiograph of the pelvis, obtained with the patient prone, shows a stent (Wallstent; Boston Scientific) extending from the left iliac vein into the inferior vena cava.

View larger version (152K): [in this window] [in a new window]   Figure 45.  Inferior vena cava filter and ureteral stent. Magnified anteroposterior image of the middle abdomen shows an inferior vena cava filter (Trapease; Cordis Endovascular, Miami, Fla) (arrow) and the superior portion of a double-J ureteral stent (Percuflex; Boston Scientific) (arrowhead).

View larger version (150K): [in this window] [in a new window]   Figure 46.  Inferior vena cava filter. Magnified anteroposterior radiograph of the abdomen shows an inferior vena cava filter (Over the Wire Greenfield; Boston Scientific). The tip of a hemostat is seen pointing to the filter.

View larger version (96K): [in this window] [in a new window]   Figure 47.  Transjugular intrahepatic portal caval shunt. Anteroposterior radiograph of the abdomen shows a transjugular intrahepatic portal caval shunt (Wallstent, Boston Scientific).