Lines/Tubes/Devices – Page 2

Case 16

ICU/Surgery, Lines/Tubes/Devices / Age >61, Aortic Valve Replacement, Atelectasis (Compressive/Passive), Endotracheal Tube, Enteric Tube, Left Atrial Appendage Closure Device, Loop Recorder, Malposition, Portable, Watchman

This radiograph demonstrates a malpositioned enteric tube which is looped in the oropharynx/hypopharynx. There are a number of incidental findings including an appropriately positioned endotracheal tube, a loop recorder projecting over the left chest wall, postsurgical changes of sternotomy with a prosthetic aortic valve, and a Watchman left atrial appendage occlusion device which is difficult to see on the default window and level. The lung volumes are low overall with some linear subsegmental atelectasis in the left lung base.

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Case 15

ICU/Surgery, Lines/Tubes/Devices / Age <30, Atelectasis (Lung), Bronchial Intubation, Endotracheal Tube, Enteric Tube, Malposition, Portable

This radiograph demonstrates a malpositioned endotracheal tube in the right main bronchus with resultant atelectasis of the entire left lung. The heart is shifted toward the left side. This supports the diagnosis of atelectasis over a large pleural effusion, which would look similar except that the heart would shift to the contralateral side. An enteric tube is also seen entering the stomach and terminating inferiorly beyond the border of the study. EKG wires, bra clasps, and bra underwires are seen externally.

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Case 14

Lines/Tubes/Devices / Age >61, Malposition, Peripherally Inserted Central Catheter, PICC, Portable

This radiograph demonstrates a malpositioned left upper extremity PICC (peripherally inserted central catheter). The tip is turned upward within the superior vena cava and is beginning to course medially, consistent with placement in the azygous vein. A lateral radiograph may be helpful to confirm, if available. The study is otherwise unremarkable for the patient’s age.

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Case 13

Lines/Tubes/Devices / Age >61, Left Atrial Appendage Closure Device, Portable, Watchman

This radiograph demonstrates an endovascular left atrial appendage closure device, in this case a Watchman™ device, projecting over the left heart. This prevents clot formation in the left atrial appendage in atrial fibrillation patients, which could otherwise embolize to the brain and cause stroke. The exam is otherwise unremarkable for the patient’s age.

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Case 10

Lines/Tubes/Devices / Age >61, Vagal Nerve Stimulator

This radiograph demonstrates a vagal nerve stimulator generator pack projecting over the left hemithorax with a thin lead tracking to the left base of neck. At first glance this may be mistaken for a pacemaker, but the course and caliber of the lead indicate that this is a different device. The exam is otherwise unremarkable.

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