Critically ill patients often require multiple invasive devices for support and monitoring, including endotracheal tubes (ETT), central venous catheters (CVCs), chest drainage tubes, nasogastric tubes (NGTs), and pacemakers. Device-related complications can worsen outcomes if not recognized promptly.

Mechanisms of injury include:

• Traumatic placement: Excessive force, improper angle, or anatomical variation can result in airway rupture, vascular perforation, or lung parenchymal laceration.
• Overinflation of balloons: Leading to tracheal tears, mediastinal emphysema, and subcutaneous emphysema.
• Malposition/migration: Devices intended for central veins can migrate into arteries or the cardiac chambers, while nasogastric tubes may inadvertently enter the airway.

A systematic radiological approach is essential. CXR remains the primary imaging modality in critically ill patients for rapid assessment of line placement, pneumothorax, and gross parenchymal changes. Ultrasound is invaluable at the bedside for vascular integrity and ruling out thrombosis. CT offers high-resolution visualization of complex injuries and confirms complex injuries and clarifies uncertain findings.