Medical Devices of the Abdomen and Pelvis

doi:10.1148/rg.252045157

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Medical Devices of the Abdomen and Pelvis¹

Tim B. Hunter, MD and Mihra S. Taljanovic, MD

¹ From the Department of Radiology, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067. Received August 10, 2004; revision requested August 25 and received September 15; accepted September 17. Both authors have no financial relationships to disclose.

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Figure 1. Traditional nasogastric tube. Chest radiograph shows the tip of a nasogastric tube (arrow) in the fundus of the stomach. Electrocardiographic leads on the chest and left lower lobe atelectasis are seen.

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Figure 2. Supine abdominal view shows a feeding tube with its tip in the descending portion of the duodenum (white arrow). A right femoral catheter (black arrow), a gown snap (G), a Foley catheter (F), and a unipolar left hip hemiarthroplasty (*) are also visible.

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Figure 3. Abdominal radiograph shows the recent placement of a gastrostomy tube (arrows). Note the tube balloon (B) in the stomach lumen, the surgical clips outside the stomach, and the Dacron cuff (D) in the subcutaneous tissues of the anterior abdominal wall. The cuff incites a soft-tissue reaction, which helps anchor the tube.

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Figure 4a. (a) Photograph of a PEG button. The acorn-shaped portion of the button (*) is pulled up against the wall of the stomach to hold the button in place, while the cylindrical portion of the button (**) traverses the anterior abdominal wall. Its opening (O) is available for instilling feedings into the stomach or for removal of gastric contents, and it can be clamped shut with the attached plug (P). (b) Lateral view of the abdomen in a young child shows a PEG button (arrows).

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Figure 4b. (a) Photograph of a PEG button. The acorn-shaped portion of the button (*) is pulled up against the wall of the stomach to hold the button in place, while the cylindrical portion of the button (**) traverses the anterior abdominal wall. Its opening (O) is available for instilling feedings into the stomach or for removal of gastric contents, and it can be clamped shut with the attached plug (P). (b) Lateral view of the abdomen in a young child shows a PEG button (arrows).

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Figure 5. Bilateral ureteral stents in a 61-year-old woman. Abdominal radiograph shows the left ureteral stent, which was placed in an antegrade fashion (the tapered end is in the bladder), and the right ureteral stent, which was placed in a retrograde direction (the tapered end is in the renal pelvis). There is also a surgically placed gastrostomy tube with a Malecot tip (G), a left colostomy (O), and a flat silicone drain (D) in the pelvis.

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Figure 6. Drawing illustrates the position of the UroLume Endourethral Wallstent prosthesis in the bulbous urethra. (Courtesy of American Medical Systems, Minnetonka, Minn.)

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Figure 7a. (a) Photograph shows a typical Foley catheter. (b) Pelvic radiograph shows a suprapubic catheter (arrows), which is made visible by the surrounding contrast material in the bladder.

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Figure 7b. (a) Photograph shows a typical Foley catheter. (b) Pelvic radiograph shows a suprapubic catheter (arrows), which is made visible by the surrounding contrast material in the bladder.

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Figure 8. View of the abdomen shows a left nephrostomy tube (curved arrow); guide wires (straight arrows) in the right renal pelvis, right ureter, and right side of the bladder for placement of a right ureteral stent; skin staples from recent surgery (white arrowheads); and vascular surgical clips (black arrowheads).

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Figure 9. Pelvic radiograph shows a Lippe’s loop IUD. This type of contraceptive device has not been marketed for many years, but it still may be seen in some patients.

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Figure 10a. (a) Pelvic radiograph shows a typical IUD (arrowhead). A tampon (arrow) is present in the vagina. (b) Sagittal transvaginal pelvic US image shows a linear region of marked echogenicity (*), the normal appearance of a properly situated IUD. (c) Pelvic CT image of a different patient shows a normal IUD.

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Figure 10b. (a) Pelvic radiograph shows a typical IUD (arrowhead). A tampon (arrow) is present in the vagina. (b) Sagittal transvaginal pelvic US image shows a linear region of marked echogenicity (*), the normal appearance of a properly situated IUD. (c) Pelvic CT image of a different patient shows a normal IUD.

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Figure 10c. (a) Pelvic radiograph shows a typical IUD (arrowhead). A tampon (arrow) is present in the vagina. (b) Sagittal transvaginal pelvic US image shows a linear region of marked echogenicity (*), the normal appearance of a properly situated IUD. (c) Pelvic CT image of a different patient shows a normal IUD.

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Figure 11. Pelvic radiograph shows bilateral tubal ligation clips.

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Figure 12. Frontal view of the pelvis shows a large pessary (arrows) that was placed in the vagina to support the uterus and prevent uterine prolapse.

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Figure 13. Frontal view of the left hip shows a bipolar hip hemiarthroplasty and a malleable penile prosthesis.

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Figure 14a. Frontal (a) and lateral (b) radiographs of the pelvis show a tandem (T) and ovoids (O) used to treat a gynecologic malignancy with brachytherapy.

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Figure 14b. Frontal (a) and lateral (b) radiographs of the pelvis show a tandem (T) and ovoids (O) used to treat a gynecologic malignancy with brachytherapy.

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Figure 15. Thorium dioxide (Thorotrast) deposition in the spleen of a 57-year-old man. Abdominal radiograph shows opacity in the spleen (arrows), which does not represent dystrophic calcifications but actually Thorotrast with its high atomic number. The spleen is small because of radiation fibrosis. (Courtesy of George Barnes, Jr, MD, University Medical Center, Tucson, Ariz.)

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Figure 16a. Surgical clips and staples. (16) Photographs show skin clips (a), skin staples (b), and tantalum hemostatic clips (c).

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Figure 16b. Surgical clips and staples. (16) Photographs show skin clips (a), skin staples (b), and tantalum hemostatic clips (c).

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Figure 16c. Surgical clips and staples. (16) Photographs show skin clips (a), skin staples (b), and tantalum hemostatic clips (c).

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Figure 17a. (a) Magnified image of the right lung shows small surgical staples (arrow) used to repair the lung after resection of a cavity. (b) Oblique view of the lumbar spine shows skin clips (SC), hemostatic clips (H), an iliac artery stent graft (VS), and two double rows of tiny surgical staples (arrow) from a recent bowel resection and anastomosis. There is also residual contrast material in the colon.

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Figure 17b. (a) Magnified image of the right lung shows small surgical staples (arrow) used to repair the lung after resection of a cavity. (b) Oblique view of the lumbar spine shows skin clips (SC), hemostatic clips (H), an iliac artery stent graft (VS), and two double rows of tiny surgical staples (arrow) from a recent bowel resection and anastomosis. There is also residual contrast material in the colon.

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Figure 18a. Surgical sponges. (a) Photograph shows laparotomy sponges (1), Rey-Tec sponges (2), surgical patties (3), Neuro sponges (4), and Tonsil sponges (5). (b) Radiograph of these same sponges with the same orientation of the sponges. Note the various types of metallic identifying markers. (The sponges were provided by Stefen Wigert, RN.) (c) Radiograph obtained during spinal surgery to ascertain correct placement of pedicle screws. A laparotomy sponge (arrow) and Rey-Tec sponges (arrowheads) are visible. (d) Radiograph of the left upper chest obtained immediately after placement of a pacemaker shows retained surgical sponges (S).

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Figure 18b. Surgical sponges. (a) Photograph shows laparotomy sponges (1), Rey-Tec sponges (2), surgical patties (3), Neuro sponges (4), and Tonsil sponges (5). (b) Radiograph of these same sponges with the same orientation of the sponges. Note the various types of metallic identifying markers. (The sponges were provided by Stefen Wigert, RN.) (c) Radiograph obtained during spinal surgery to ascertain correct placement of pedicle screws. A laparotomy sponge (arrow) and Rey-Tec sponges (arrowheads) are visible. (d) Radiograph of the left upper chest obtained immediately after placement of a pacemaker shows retained surgical sponges (S).

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Figure 18c. Surgical sponges. (a) Photograph shows laparotomy sponges (1), Rey-Tec sponges (2), surgical patties (3), Neuro sponges (4), and Tonsil sponges (5). (b) Radiograph of these same sponges with the same orientation of the sponges. Note the various types of metallic identifying markers. (The sponges were provided by Stefen Wigert, RN.) (c) Radiograph obtained during spinal surgery to ascertain correct placement of pedicle screws. A laparotomy sponge (arrow) and Rey-Tec sponges (arrowheads) are visible. (d) Radiograph of the left upper chest obtained immediately after placement of a pacemaker shows retained surgical sponges (S).

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Figure 18d. Surgical sponges. (a) Photograph shows laparotomy sponges (1), Rey-Tec sponges (2), surgical patties (3), Neuro sponges (4), and Tonsil sponges (5). (b) Radiograph of these same sponges with the same orientation of the sponges. Note the various types of metallic identifying markers. (The sponges were provided by Stefen Wigert, RN.) (c) Radiograph obtained during spinal surgery to ascertain correct placement of pedicle screws. A laparotomy sponge (arrow) and Rey-Tec sponges (arrowheads) are visible. (d) Radiograph of the left upper chest obtained immediately after placement of a pacemaker shows retained surgical sponges (S).

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Figure 19a. (a) Radiograph of a patient with complications from multiple surgical procedures demonstrates a flat silicone drain (arrowheads), large retention suture bridges (arrows), a colostomy (O), and a sump drain (SD) in the pelvis. There is also contrast material (*) in a mucus fistula. (b) Abdominal radiograph of a different patient shows a T-tube biliary drain (black arrow) and a left Malecot nephrostomy tube (white arrow).

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Figure 19b. (a) Radiograph of a patient with complications from multiple surgical procedures demonstrates a flat silicone drain (arrowheads), large retention suture bridges (arrows), a colostomy (O), and a sump drain (SD) in the pelvis. There is also contrast material (*) in a mucus fistula. (b) Abdominal radiograph of a different patient shows a T-tube biliary drain (black arrow) and a left Malecot nephrostomy tube (white arrow).

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Figure 20a. (a) Radiograph shows an internal biliary stent. (b) Radiograph of a different patient with biliary strictures treated with right and left external biliary drainage shows the locking pigtail catheters (C) and two metallic Gianturco-Rosch Z stents (arrows).

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Figure 20b. (a) Radiograph shows an internal biliary stent. (b) Radiograph of a different patient with biliary strictures treated with right and left external biliary drainage shows the locking pigtail catheters (C) and two metallic Gianturco-Rosch Z stents (arrows).

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Figure 21a. (a) Frontal view of the pelvis shows a right iliac arterial stent placed for atherosclerotic occlusive vascular disease. There are also multiple small metallic coils from past embolotherapy. (b) Supine view of the abdomen in a different patient shows aortic and iliac stent grafts for treatment of an abdominal aortic aneurysm. There is also an inflated Foley balloon in the bladder. (c) Longitudinal US scan of the liver in a different patient shows a TIPS catheter (arrows).

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Figure 21b. (a) Frontal view of the pelvis shows a right iliac arterial stent placed for atherosclerotic occlusive vascular disease. There are also multiple small metallic coils from past embolotherapy. (b) Supine view of the abdomen in a different patient shows aortic and iliac stent grafts for treatment of an abdominal aortic aneurysm. There is also an inflated Foley balloon in the bladder. (c) Longitudinal US scan of the liver in a different patient shows a TIPS catheter (arrows).

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Figure 21c. (a) Frontal view of the pelvis shows a right iliac arterial stent placed for atherosclerotic occlusive vascular disease. There are also multiple small metallic coils from past embolotherapy. (b) Supine view of the abdomen in a different patient shows aortic and iliac stent grafts for treatment of an abdominal aortic aneurysm. There is also an inflated Foley balloon in the bladder. (c) Longitudinal US scan of the liver in a different patient shows a TIPS catheter (arrows).

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Figure 22. Pelvic radiograph of a motor vehicle accident victim, who has hypotension from internal bleeding, shows metallic embolization coils (arrows) in the internal iliac artery distribution. There are sacral and pelvic fractures, large abdominal retention suture bridges (RB), skin staples, external fixator pins in the iliac bones, and prominent linear opacities (arrowhead) produced by a trauma board.

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Figure 23. Collimated view of the middle abdomen shows a typical inferior vena cava filter.

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Figure 24. Collimated view of the pelvis shows a Gore-Tex left femoral to right femoral artery bypass graft (white arrows) for an obstructed left iliac artery. There is also a Palmaz stent in the right external iliac artery (black arrow).

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Figure 25a. (a) Collimated frontal view of the lumbosacral junction shows a drop of Pantopaque contrast material (arrow) remaining from past myelography. Hemostatic clips and pedicle screws are also visible. (b) Collimated view of the upper abdomen in another patient shows Pepto-Bismol (arrows) in the stomach and jejunum. (c) CT scan of a third patient demonstrates lymphangiographic contrast material in the paracaval and paraaortic lymph nodes (arrows). (d) Frontal view of the pelvis in an elderly patient shows a colostomy (arrows), surgical clips from a prostate resection, and residual contrast material in scattered colonic diverticula.

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Figure 25b. (a) Collimated frontal view of the lumbosacral junction shows a drop of Pantopaque contrast material (arrow) remaining from past myelography. Hemostatic clips and pedicle screws are also visible. (b) Collimated view of the upper abdomen in another patient shows Pepto-Bismol (arrows) in the stomach and jejunum. (c) CT scan of a third patient demonstrates lymphangiographic contrast material in the paracaval and paraaortic lymph nodes (arrows). (d) Frontal view of the pelvis in an elderly patient shows a colostomy (arrows), surgical clips from a prostate resection, and residual contrast material in scattered colonic diverticula.

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Figure 25c. (a) Collimated frontal view of the lumbosacral junction shows a drop of Pantopaque contrast material (arrow) remaining from past myelography. Hemostatic clips and pedicle screws are also visible. (b) Collimated view of the upper abdomen in another patient shows Pepto-Bismol (arrows) in the stomach and jejunum. (c) CT scan of a third patient demonstrates lymphangiographic contrast material in the paracaval and paraaortic lymph nodes (arrows). (d) Frontal view of the pelvis in an elderly patient shows a colostomy (arrows), surgical clips from a prostate resection, and residual contrast material in scattered colonic diverticula.

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Figure 25d. (a) Collimated frontal view of the lumbosacral junction shows a drop of Pantopaque contrast material (arrow) remaining from past myelography. Hemostatic clips and pedicle screws are also visible. (b) Collimated view of the upper abdomen in another patient shows Pepto-Bismol (arrows) in the stomach and jejunum. (c) CT scan of a third patient demonstrates lymphangiographic contrast material in the paracaval and paraaortic lymph nodes (arrows). (d) Frontal view of the pelvis in an elderly patient shows a colostomy (arrows), surgical clips from a prostate resection, and residual contrast material in scattered colonic diverticula.

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Figure 26. Radiograph of a patient with an abdominal wall defect shows the tantalum mesh (arrows) used to repair the defect.

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Figure 27a. Frontal (a) and lateral (b) views show a umbilical venous catheter (UVC) and umbilical arterial catheter (UAC) in a neonate. Note the umbilicus (U) on the frontal view. The two views were taken at different times. The umbilical arterial catheter is in a somewhat higher position than is normally seen.

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Figure 27b. Frontal (a) and lateral (b) views show a umbilical venous catheter (UVC) and umbilical arterial catheter (UAC) in a neonate. Note the umbilicus (U) on the frontal view. The two views were taken at different times. The umbilical arterial catheter is in a somewhat higher position than is normally seen.

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Figure 28a. (a) Collimated frontal view of the pelvis shows a peritoneal dialysis catheter (arrows). Note the Dacron cuff (D) portion of the catheter. The cuff incites a soft-tissue reaction that helps anchor the catheter. The arrow on the patient’s far right side shows the portion of the catheter outside the patient. (b) Frontal view of the abdomen and pelvis shows the typical appearance of a ventriculoperitoneal catheter (arrow). Note also the presence of a PEG tube (P) in the distal portion of the stomach and congenital developmental dysplasia of the right hip. Because of the patient’s body habitus, the distal portion of the stomach lies to the right of the spine.

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Figure 28b. (a) Collimated frontal view of the pelvis shows a peritoneal dialysis catheter (arrows). Note the Dacron cuff (D) portion of the catheter. The cuff incites a soft-tissue reaction that helps anchor the catheter. The arrow on the patient’s far right side shows the portion of the catheter outside the patient. (b) Frontal view of the abdomen and pelvis shows the typical appearance of a ventriculoperitoneal catheter (arrow). Note also the presence of a PEG tube (P) in the distal portion of the stomach and congenital developmental dysplasia of the right hip. Because of the patient’s body habitus, the distal portion of the stomach lies to the right of the spine.

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Figure 29. Scout image from a CT study shows a chemotherapy infusion pump (P) in the anterior abdominal wall. A catheter (straight arrow) extends from the pump for instillation of medication directly into the peritoneum. Surgical clips (*) are present in the pelvis, and there is also a colostomy (curved arrow) faintly visible.

Medical Devices of the Abdomen and Pelvis1

Medical Devices of the Abdomen and Pelvis¹