Abstract
This chapter describes the routine appearance and abnormal positions of a variety of monitoring and support devices, including endotracheal and tracheostomy tubes, nasogastric and Dobhoff tubes, PICC lines, and other vascular catheters, chest tubes, and pacer/ICD wires.
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Reference
Eisenberg RL, Johnson NM, editors. Comprehensive Radiographic Pathology. 6th ed. St. Louis: Elsevier/Mosby; 2016.
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Fig. e4.1
Malpositioned endotracheal tube. Excessively low position of the tube in the bronchus intermedius (arrow) causes collapse of the right upper lobe and the entire left lung [1] (TIF 539 kb)
Fig. e4.2
Malpositioned tracheostomy tube. The tip (white arrow) lies too close to the carina (black arrow). (Courtesy of Paul Spirn, MD, Boston) (TIF 855 kb)
Fig. e4.3
Malpositioned right subclavian PICC line. The tip (arrows) extends into the ipsilateral jugular venous system (TIF 1405 kb)
Fig. e4.4
Malpositioned left subclavian PICC line. The catheter extends into a persistent left SVC (arrows) (TIF 1528 kb)
Fig. e4.5
Situs inversus simulating malpositioned PICC line. The left subclavian PICC line extends to a persistent left SVC (arrows), but due to the malformation, the tip is correctly positioned just above the right atrium (TIF 1270 kb)
Fig. e4.6
Coiled PICC lines. (a) Right brachiocephalic vein (arrows) (TIF 1131 kb)
Fig. e4.6
Coiled PICC lines. (b) Left subclavian catheter (arrows) extends to the brachiocephalic vein close to the midline, before turning back on itself so that the tip is in the ipsilateral internal jugular vein (arrows) (TIF 1609 kb)
Fig. e4.7
Right IJ catheter tip in the aorta. (a) The catheter passes to the left of the midline. (Courtesy of Paul Spirn, MD, Boston) (TIF 2225 kb)
Fig. e4.7
Right IJ catheter tip in the aorta. (b) Contrast CT scans show the catheter (white arrow) within the right carotid artery, medial to the superior vena cava (black arrow in c). (Courtesy of Paul Spirn, MD, Boston) (TIF 998 kb)
Fig. e4.7
Right IJ catheter tip in the aorta. (c) Contrast CT scans show the catheter (white arrow) within the right carotid artery, medial to the superior vena cava (black arrow in c). (Courtesy of Paul Spirn, MD, Boston) (TIF 1184 kb)
Fig. e4.7
Right IJ catheter tip in the aorta. (d) In the final image, the catheter (black arrow) passes into the aortic arch, well medial to the contrast-filled brachiocephalic vein (white arrow). (Courtesy of Paul Spirn, MD, Boston) (TIF 1109 kb)
Fig. e4.8
Mediastinal hematoma complicating insertion of tunneled right IJ catheter. (a) The catheter extends to the region of the junction of the IJ and right subclavian vein before curling back on itself to point upward in the neck (black arrows). There is increased opacification along the trachea with marked widening of the right paratracheal stripe. Note that there is also an abnormal position of the left subclavian PICC line, which crosses the midline into the right subclavian venous system. (Courtesy of Paul Spirn, MD, Boston) (TIF 1724 kb)
Fig. e4.8
Mediastinal hematoma complicating insertion of tunneled right IJ catheter. (b) CT image confirms the mediastinal hematoma. (Courtesy of Paul Spirn, MD, Boston) (TIF 982 kb)
Fig. e4.9
Broken central venous catheter. The sheared off portion of the catheter (arrows) is located in the left lower lobe [1] (TIF 862 kb)
Fig. e4.10
Malpositioned Swan-Ganz catheter causing pulmonary infarct. (a) Initial radiograph is within normal limits (TIF 1677 kb)
Fig. e4.10
Malpositioned Swan-Ganz catheter causing pulmonary infarct. (b) Placement of a Swan-Ganz catheter well beyond the mediastinal margin of the right pulmonary artery (black arrow) has resulted in a wedge-shaped infarct in the right lower lobe (white arrows), with its apex close to the tip of the catheter (TIF 1617 kb)
Fig. e4.11
Malpositioned IABP. The opaque tip (arrow) is below the left main bronchus and approximately 5 cm below the top of the transverse arch of the aorta (TIF 1404 kb)
Fig. e4.12
Malpositioned IABP. The opaque tip (white arrow) extends to the aortic arch, proximal to the origin of the left subclavian artery. Note also the misplaced Swan-Ganz catheter, inserted from a femoral approach, with its tip (black arrow) well beyond the mediastinal border of the right pulmonary artery. (Courtesy of Paul Spirn, MD, Boston) (TIF 6331 kb)
Fig. e4.13
IABP with dilated balloon producing a lucent, sausage-like mass (black arrows). (a) Opaque tip is in good position (arrow) (TIF 1001 kb)
Fig. e4.13
IABP with dilated balloon producing a lucent, sausage-like mass (black arrows). (b) Opaque tip has a very low position (white arrow) (TIF 1157 kb)
Fig. e4.14
Misplaced Dobhoff tube in the right bronchial tree (arrow). The white circles are related to the trauma board underneath the patient in the emergency department (TIF 1226 kb)
Fig. e4.15
Malpositioned Dobhoff tube. In this patient with multiple internal and external tubes and wires, the Dobhoff tube extends into the right bronchial tree (white arrows) to the costophrenic angle, where it perforates the pleura and then coils to the left (black arrow) (TIF 4901 kb)
Fig. e4.16
Malpositioned Dobhoff tube coiled in the neck (arrows) (TIF 938 kb)
Fig. e4.17
Malpositioned Dobhoff tube. It extends to the midesophagus before coiling on itself to go back to the mouth (arrows). (An earlier image of the same patient is Fig. e4.14) (TIF 989 kb)
Fig. e4.18
Proper positioning of single-channel cardiac device. Inserted from the inferior vena cava, it extends to the right ventricle (arrows). The patient had an SVC abnormality that precluded insertion of the pacer from above (TIF 1655 kb)
Fig. e4.19
Proper position of dual-channel cardiac device. (a) The leads extend to the right atrium (white arrows) and right ventricle (black arrows). Note the anterior position of both of these cardiac chambers (TIF 285 kb)
Fig. e4.19
Proper position of dual-channel cardiac device. (b) The leads extend to the right atrium (white arrows) and right ventricle (black arrows). Note the anterior position of both of these cardiac chambers (TIF 1048 kb)
Fig. e.4.20
Right atrial pacer lead in a persistent left superior vena cava (white arrow). Note that the right ventricular lead passes with the right-sided SVC (black arrow) (TIF 1829 kb)
Fig. e4.21
Retained pacer tip. (a) The small linear opacification (arrow) was not appreciated on multiple previous portable examinations (TIF 905 kb)
Fig. e4.21
Retained pacer tip. (b) Image before the pacer was removed shows that the tip lies along the course of the previous wire (arrow) (TIF 559 kb)
Fig. e.4.22
Proper positioning of chest tube to drain a loculated effusion. (a) Initial image shows that the pigtail chest tube (white arrow) has not drained the loculated effusion (black arrows) because it is not within it (TIF 2780 kb)
Fig. e.4.22
Proper positioning of chest tube to drain a loculated effusion. (b) Repeat study soon after insertion of a new chest tube into the fluid collection shows substantial drainage of the loculated effusion (arrow) (TIF 1090 kb)
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Eisenberg, R.L. (2020). Tubes, Lines, and Catheters and Their Complications. In: What Radiology Residents Need to Know: Chest Radiology . Springer, Cham. https://doi.org/10.1007/978-3-030-16826-1_4
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DOI: https://doi.org/10.1007/978-3-030-16826-1_4
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