ALL PULSE GENERATORS IN CHEST XRAY ARE NOT CARDIAC

Since it has become universal not  to receive clinical notes for any Chest Xray, it has become that much more difficult for the residents and consultants to become aware that all pulse generators of the chest are  not cardiac pacemakers. This an example of chest X ray done with history of cough  with DBS generators with leads travelling cranially. Submitted by Dr MGK Murthy.

  (A) DBS- Deep Brain stimulator (DBS) is used to stimulate and control the various movement disorders particularly dystocia and parkinsonism. It consists of an electrical pulse generator and insulated wires.  Electrodes extend from the thalamus subcutaneously down the patient's neck and connect to a pulse generator usually located under the clavicle

(B) Others include

·   Repetitive  vagal stimulator for refractory seizures and more recently  for intractable hiccups

·    Spinal cord stimulator -Placed for intractable pain management  with leads at D9 to L1 in epidural space and generator beneath the abdominal skin laterally

·    Gastric stimulators for gastroparesis to enhance emptying

·     Urinary bladder stimulators

·    Diaphragmatic stimulators with receivers beneath the domes and leads along the phrenic nerves paraspinally

·     Bone stimulators in close contact to promote healing