E2181. Imaging Features of Modern Chest Devices: A Radiographic Review
  1. Krunal Moradiya; Henry Ford Health System
  2. Aditya Karandikar; Henry Ford Health System
  3. Ishani Dalal; Henry Ford Health System
In modern medicine, a wide variety of chest devices are used in the settings of chronic disease and emergency management. Over the years, device-related therapy has improved in both form and function. Novel engineering of chest devices, and particularly cardiac devices, has occurred alongside development of percutaneous and minimally invasive procedures. Contemporary thoracic devices often adapt on earlier designs, bear complex appearance, and mimic one another, making identification on imaging a difficult task. For preliminary imaging of thoracic devices, plain radiography is a practical choice. To serve as effective clinical colleagues, radiologists should be familiar with the radiographic features of thoracic devices and their correlation to patient care.

Educational Goals / Teaching Points
This exhibit will review the radiographic features of chest devices, their function, proper placement, and associated medical complications. Relevant thoracic anatomy and radiographic landmarks will be described beforehand, as devices can be located at many different sites and span various distances within the chest. The positions of cardiac valves will also be emphasized, as many devices traverse these structures. The reader will be taught about both common and uncommon devices, including recent innovations. By the end of this exhibit, the reader will better understand modern chest devices and their principal features in the context of chest radiographs.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Both noncardiac and cardiac devices will be reviewed, including central lines, spinal cord stimulators, chest tubes, and pacemakers, among many others. Although ultrasound and computed tomography (CT) can better assess infection, thromboembolism, and tissue trauma, radiography can appraise other contributory and/or concomitant complications of chest devices, such as malposition, migration, fracture, pneumothorax, atelectasis, and pneumopericardium. Evaluation of these salient complications and others will be highlighted. Some devices have lead or electrode components that are prone to damage, so proper placement of these elements will be underscored. Radiographic signs like the “O” sign of gastric bands and “ghost drainage” sign of chest tubes will be reviewed. Moreover, new transcatheter devices have various profiles on radiographs. For example, the MitraClip (Abbott Laboratories) and Sapien EVOQUE (Edwards Lifesciences) are both indicated for mitral regurgitation, but they have considerable differences in morphology. Other devices, like leadless pacemakers, acid reflux monitors, and implantable loop recorders, have similar appearances but distinctive functions. After this exhibit, the reader will come to appreciate the wide scope and heterogeneity of such thoracic devices.

Device-based therapies play a critical role in medical treatment and continue to see technological advancement. For most devices, plain radiographic images are pragmatic for initial assessment. As new devices are developed to address ongoing medical needs, proper evaluation of devices on chest radiographs will remain an essential skill.