CTICasesMalpositioned Left Axillary Intra-aortic Balloon Pump
Imaging findings
On a chest radiograph of a patient in cardiogenic shock, an intra-aortic balloon pump (IABP) is seen with its proximal marker located abnormally high, superior to the aortic arch. This represents an atypical "upside down" placement, which is used when the device is introduced via the left axillary or subclavian artery to facilitate patient ambulation. The proximal marker is seen above the arch, and the sheath is visible in the left axillary artery.
Key takeaways
When an intra-aortic balloon pump is placed via the left axillary or subclavian artery, the catheter is oriented upside down compared to traditional femoral access. On radiographs, the radiopaque marker is positioned superiorly near the aortic arch, and correction of a high position requires advancing the catheter further rather than pulling it back. Correct positioning is crucial to avoid arterial dissection, occlusion of neck vessels, or visceral artery occlusion if positioned too low, as well as to maintain effective counterpulsation.
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