What is the radiographic appearance of a transvenous pacemaker or automatic implantable cardioverter defibrillator (AICD)?
The power/generator pack for a transvenous pacemaker or AICD is located subcutaneously in the pectoral area of the anterior chest wall and appears as a radiopaque, round, ovoid, or rectangular structure that is approximately 5 cm in diameter on a frontal chest radiograph. The metallic lead or leads appear as dense, thin curvilinear radiopacities (with associated thicker short segments of spring defibrillation coils in the case of an AICD) that usually course through the subclavian or internal jugular vein from the generator pack to pass through the brachiocephalic vein and SVC, subsequently terminating in the right atrium, right ventricle, or coronary sinus
