Intra-aortic balloon pump
Intra-aortic balloon pump. The tiny metallic density projected to the left of the carina in this patient (arrow) represents the radio-opaque marker of an IABP, and indicates that we are dealing with a very sick patient in cardiogenic shock. The balloon itself is not radio-opaque, but the marker is used to assess balloon position – it should be in the proximal descending aorta (as in this case), so that it is located beyond the origin of the left subclavian artery. Note that this patient also has a ‘batwing’ pattern of pulmonary alveolar oedema.