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Medical Devices of the Chest¹

¹ From the Department of Radiology (T.B.H., M.S.T., W.G.B., J.R.S.) and Department of Cardiovascular and Thoracic Surgery (P.H.T.), University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067. Received March 10, 2004; revision requested April 22 and received June 10; accepted June 11. All authors have no financial relationships to disclose. Address correspondence to T.B.H. (e-mail: tbh@3towers.com).

View larger version (141K): [in a new window]   Figure 1.  Typical postoperative cardiac surgery chest radiograph. First postoperative study for a 58-year-old radiologist (!) who underwent coronary artery bypass graft (CABG) surgery. The image is underexposed and shows a confusing array of apparatus, including overlying oxygen tubing, a pulmonary artery catheter, a nasogastric tube, an endotracheal tube, a mediastinal drain, median sternotomy wires, mediastinal clips, electrocardiographic (ECG) leads, and incipient left lower lobe atelectasis and pleural fluid.

View larger version (113K): [in a new window]   Figure 2.  Chest radiograph shows halo apparatus (with emergency wrench close at hand) for cervical spine stabilization.

View larger version (164K): [in a new window]   Figure 3.  Chest radiograph reveals an external pacemaker-defibrillator electrode plate overlying the left side of the chest. The rectangular Chinese character-like electrode (white arrows) goes on the patient’s back, and the round electrode (black arrows) goes on the patient’s front.

View larger version (167K): [in a new window]   Figure 4.  Frontal view of the chest shows a tissue expander (arrow) for subsequent breast reconstruction.

View larger version (155K): [in a new window]   Figure 5a.  Frontal (a) and lateral (b) views show a thoracostomy tube in good position for treatment of a pneumothorax but not for an effusion.

View larger version (130K): [in a new window]   Figure 5b.  Frontal (a) and lateral (b) views show a thoracostomy tube in good position for treatment of a pneumothorax but not for an effusion.

View larger version (132K): [in a new window]   Figure 6.  Frontal view of the chest shows a pigtail catheter that had been inserted under fluoroscopic guidance into a loculated right empyema for instillation of urokinase and fluid drainage.

View larger version (144K): [in a new window]   Figure 7.  Frontal view of the chest shows "ping-pong ball plombage" in the right apex, as well as a cardiac pacemaker.

View larger version (151K): [in a new window]   Figure 8.  Frontal view of the chest shows a right apical oleothorax (wax plombage). Extensive pleural calcification includes the surface of the wax ball (arrows).

View larger version (162K): [in a new window]   Figure 9.  Chest radiograph shows that the tip of the endotracheal tube (black arrow) is slightly above the aortic arch and well above the carina, in good position. A right chest tube (white arrow), ECG leads (E), a gown snap (G), and oxygen tubing (O) are also visible.

View larger version (124K): [in a new window]   Figure 10.  Frontal view shows a double-lumen endotracheal tube with selective intubation of the left main bronchus (arrow).

View larger version (130K): [in a new window]   Figure 11.  Frontal view of the chest shows a feeding tube that was inadvertently placed in the patient’s airway, perforating the lung and lying in the pleural space.

View larger version (141K): [in a new window]   Figure 12.  Chest radiograph of an elderly man with recurrent pneumonia and difficulty swallowing shows a dental appliance (arrow) in the esophagus at the thoracic inlet.

View larger version (169K): [in a new window]   Figure 13a.  (a) Frontal view of the chest shows an esophageal stent (black arrows) that was placed to ameliorate the effects of an esophageal malignancy. There are also two chest tubes (*), a peripherally inserted central catheter (white arrow), ECG leads (E), a gown snap (G), and a transjugular intrahepatic portosystemic shunt (T) in the liver. (b) Frontal chest radiograph of an infant shows a pH probe.

View larger version (157K): [in a new window]   Figure 13b.  (a) Frontal view of the chest shows an esophageal stent (black arrows) that was placed to ameliorate the effects of an esophageal malignancy. There are also two chest tubes (*), a peripherally inserted central catheter (white arrow), ECG leads (E), a gown snap (G), and a transjugular intrahepatic portosystemic shunt (T) in the liver. (b) Frontal chest radiograph of an infant shows a pH probe.

View larger version (144K): [in a new window]   Figure 14.  Frontal chest radiograph demonstrates a tracheoesophageal voice prosthesis (arrow).

View larger version (157K): [in a new window]   Figure 15.  Frontal view of the chest in a patient with a transplanted left lung reveals a left bronchial stent (arrow) and surgical clips.

View larger version (130K): [in a new window]   Figure 16.  Portable chest radiograph shows a right subclavian single-lumen central venous catheter and a left subcutaneous port catheter, which enters via the left subclavian vein. Both catheter tips are in the superior vena cava.

View larger version (162K): [in a new window]   Figure 17.  Frontal chest radiograph shows a right jugular Swan-Ganz catheter with its tip (arrow) in the right lower pulmonary artery.

View larger version (139K): [in a new window]   Figure 18.  Frontal chest radiograph shows a Swan-Ganz catheter (white arrow) in the left pulmonary artery via the inferior vena cava. Note also the bilateral chest tubes (black arrows) and ECG leads (E).

View larger version (151K): [in a new window]   Figure 19a.  (a) Frontal view of the chest shows a left subclavian Groshong catheter with its tip in the proximal most portion of the superior vena cava. (b) Close up view of the catheter tip.

View larger version (157K): [in a new window]   Figure 19b.  (a) Frontal view of the chest shows a left subclavian Groshong catheter with its tip in the proximal most portion of the superior vena cava. (b) Close up view of the catheter tip.

View larger version (113K): [in a new window]   Figure 20.  Frontal view of the chest shows a left jugular Swan-Ganz catheter (arrows), which passes through a persistent left superior vena cava into the coronary sinus, through the right atrium and right ventricle, and into the right pulmonary artery. Also seen are a subcutaneous port (P), an endotracheal tube (ET), an ECG lead (E), and a nasogastric tube (not labeled).

View larger version (139K): [in a new window]   Figure 21.  Mechanical heart valve. Lateral view of the chest shows a Hemex tilting bileaflet mechanical mitral valve prosthesis. Median sternotomy wires and surgical clips are also evident.

View larger version (148K): [in a new window]   Figure 22.  Mechanical heart valve. Lateral view of the chest shows a Starr-Edwards caged ball mechanical mitral valve prosthesis.

View larger version (169K): [in a new window]   Figure 23.  Biologic heart valve. Frontal view of the chest shows a Hancock porcine mitral valve prosthesis (arrow). A single-lead pacemaker, ECG leads, and median sternotomy wires are also seen.

View larger version (137K): [in a new window]   Figure 24.  Biologic heart valve. Collimated lateral view of the chest shows a Medtronic Hancock valve.

View larger version (146K): [in a new window]   Figure 25.  Biologic heart valve. Frontal view of the chest shows a Hancock porcine valve prosthesis in a Rastelli conduit going from the right ventricle to the pulmonary artery.

View larger version (141K): [in a new window]   Figure 26.  Lateral view of the chest in an elderly patient shows a mitral annuloplasty ring (black arrow) and a dual-lead cardiac pacemaker. Sternal wires, surgical clips, and ECG leads are also present. The sternal wires are used to close a sternal dehiscence. The patient has both horizontal sternal wires and vertical intercostal wires (white arrows).

View larger version (155K): [in a new window]   Figure 27.  Lateral view of the chest in a child shows an occlusion basket (umbrella) for treatment of an atrial septal defect.

View larger version (138K): [in a new window]   Figure 28.  Lateral view of the chest in an adult with an atrial septal defect shows an occlusion (filter) device.

View larger version (150K): [in a new window]   Figure 29.  Frontal view of the chest in a child shows an occlusion filter (arrow) used to close a patent ductus arteriosus.

View larger version (153K): [in a new window]   Figure 30a.  Frontal (a) and lateral (b) views of the chest show a single electrode epicardial "corkscrew" subxiphoid pacemaker (arrowhead in a, black arrow in b). There are also coils (white arrow) occluding a previous right Blalock-Taussig shunt. In addition, ECG leads and sternal wires are evident.

View larger version (129K): [in a new window]   Figure 30b.  Frontal (a) and lateral (b) views of the chest show a single electrode epicardial "corkscrew" subxiphoid pacemaker (arrowhead in a, black arrow in b). There are also coils (white arrow) occluding a previous right Blalock-Taussig shunt. In addition, ECG leads and sternal wires are evident.

View larger version (168K): [in a new window]   Figure 31a.  Frontal (a) and lateral (b) views show an atrioventricular sequential pacemaker with one electrode in the right atrial appendage (RA) and the other at the right ventricular apex (RV). Also shown are ECG leads (E) and the battery-control pack (B) for the pacemaker.

View larger version (153K): [in a new window]   Figure 31b.  Frontal (a) and lateral (b) views show an atrioventricular sequential pacemaker with one electrode in the right atrial appendage (RA) and the other at the right ventricular apex (RV). Also shown are ECG leads (E) and the battery-control pack (B) for the pacemaker.

View larger version (125K): [in a new window]   Figure 32a.  (a) Collimated frontal view of the chest shows typical epicardial pacing wires (arrows) coiled on the patient’s anterior chest wall after heart surgery. (b) Collimated lateral view of the chest shows the same epicardial pacing wires (arrows) as in a. Also shown but not labeled are sternal wires, surgical clips, and a central venous catheter.

View larger version (147K): [in a new window]   Figure 32b.  (a) Collimated frontal view of the chest shows typical epicardial pacing wires (arrows) coiled on the patient’s anterior chest wall after heart surgery. (b) Collimated lateral view of the chest shows the same epicardial pacing wires (arrows) as in a. Also shown but not labeled are sternal wires, surgical clips, and a central venous catheter.

View larger version (164K): [in a new window]   Figure 33.  Frontal view of the chest shows a combination biventricular pacemaker and an automatic implantable cardioverter defibrillator with a battery pack (B) and right atrial (RA), right ventricular (RV), and coronary venous (CV) leads. Note also the left ventricular calcification from a past myocardial infarction. The coronary venous lead is positioned in a vein draining the posterior inferior wall of the left ventricle so that it can stimulate functional myocardial tissue rather than the nonfunctioning tissue represented by the ventricular wall calcification and probable myocardial aneurysm.

View larger version (173K): [in a new window]   Figure 34.  Frontal view of the chest shows a typical automatic implantable cardioverter defibrillator.

View larger version (133K): [in a new window]   Figure 35a.  (a, b) Frontal (a) and lateral (b) views show a sternal fixation pin or Kirschner wire. This sternal fixation was used for a patient who underwent lung transplantation in which a "clamshell" chest incision was made, resulting in a transverse sectioning of the sternum. In this case, the sternum is best stabilized by a vertical fixation wire or pin. Note also the surgical clips overlying the heart and the root of the aorta. (c) Collimated view of a cardiac surgery patient shows a Synthes Maxillofacial Sternal Fixation System (Synthes, Paoli, Pa) (arrows).

View larger version (108K): [in a new window]   Figure 35b.  (a, b) Frontal (a) and lateral (b) views show a sternal fixation pin or Kirschner wire. This sternal fixation was used for a patient who underwent lung transplantation in which a "clamshell" chest incision was made, resulting in a transverse sectioning of the sternum. In this case, the sternum is best stabilized by a vertical fixation wire or pin. Note also the surgical clips overlying the heart and the root of the aorta. (c) Collimated view of a cardiac surgery patient shows a Synthes Maxillofacial Sternal Fixation System (Synthes, Paoli, Pa) (arrows).

View larger version (123K): [in a new window]   Figure 35c.  (a, b) Frontal (a) and lateral (b) views show a sternal fixation pin or Kirschner wire. This sternal fixation was used for a patient who underwent lung transplantation in which a "clamshell" chest incision was made, resulting in a transverse sectioning of the sternum. In this case, the sternum is best stabilized by a vertical fixation wire or pin. Note also the surgical clips overlying the heart and the root of the aorta. (c) Collimated view of a cardiac surgery patient shows a Synthes Maxillofacial Sternal Fixation System (Synthes, Paoli, Pa) (arrows).

View larger version (125K): [in a new window]   Figure 36.  Lateral view of the chest shows sternal wires (arrowhead), vascular clips of a saphenous vein bypass graft to the right coronary artery (curved arrow), and those of the left internal mammary graft to the left anterior descending coronary artery (straight arrow).

View larger version (122K): [in a new window]   Figure 37.  Lateral view of the chest shows vascular clips of internal mammary artery bypass grafts (solid arrow) and marker rings on the ascending aorta around the ostia of two saphenous vein bypass grafts (open arrows).

View larger version (119K): [in a new window]   Figure 38.  Frontal view of the chest shows a left anterior descending coronary artery stent (arrow).

View larger version (146K): [in a new window]   Figure 39.  Frontal view of the chest shows an intraaortic counterpulsation balloon used in a patient with heart failure. The balloon (black arrows) is inflated. Usually, only the balloon tip (white arrow) is visible.

View larger version (140K): [in a new window]   Figure 40a.  Frontal (a) and lateral (b) views of the chest show a Thoratec left VAD (arrow).

View larger version (126K): [in a new window]   Figure 40b.  Frontal (a) and lateral (b) views of the chest show a Thoratec left VAD (arrow).

View larger version (126K): [in a new window]   Figure 41.  Abdominal image shows a HeartMate VAD.

View larger version (151K): [in a new window]   Figure 42.  Abdominal image shows a Novacor VAD.

View larger version (144K): [in a new window]   Figure 43a.  Cropped frontal view (a) and full lateral view (b) of the chest show a CardioWest total artificial heart. Note the four prosthetic valves and the two coil, reinforced polyurethane tubes carrying pulses of compressed air to the two artificial ventricles.

View larger version (167K): [in a new window]   Figure 43b.  Cropped frontal view (a) and full lateral view (b) of the chest show a CardioWest total artificial heart. Note the four prosthetic valves and the two coil, reinforced polyurethane tubes carrying pulses of compressed air to the two artificial ventricles.

View larger version (145K): [in a new window]   Figure 44.  Collimated frontal view of the chest shows an implantable loop recorder (arrow) in the left breast of a 25-year-old woman with a history of heart palpitations and surgical repair of a tetralogy of Fallot as a young child.

View larger version (170K): [in a new window]   Figure 45.  Frontal view of the chest of a patient with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) shows numerous coils, which had been used in multiple coil embolizations to treat repeated bouts of significant hemoptysis.

View larger version (172K): [in a new window]   Figure 46.  Abdominal image shows a remote telemetry device strapped to a patient’s abdomen.

View larger version (132K): [in a new window]   Figure 47a.  Frontal (a) and lateral (b) views of the chest in a patient who had undergone vertebroplasty. The vertebroplasty material extruded from the vertebrae and entered the spinal venous system with ultimate embolization to the patient’s lungs. The patient suffered no known sequelae.

View larger version (166K): [in a new window]   Figure 47b.  Frontal (a) and lateral (b) views of the chest in a patient who had undergone vertebroplasty. The vertebroplasty material extruded from the vertebrae and entered the spinal venous system with ultimate embolization to the patient’s lungs. The patient suffered no known sequelae.

View larger version (141K): [in a new window]   Figure 48.  Portable chest radiograph of a patient undergoing extracorporeal membrane oxygenation shows pulmonary edema in the lungs and the tubing (**) going to the patient’s right carotid artery and right jugular vein. Also seen are an endotracheal tube (ET), a right internal jugular vein catheter (black arrow), a left internal jugular vein catheter (white arrows), a nasogastric tube (NG), and a feeding tube (F).