Presentation
Admitted with shortness of breath and fever. Added sounds in left chest.
Patient Data
Left upper zone consolidation with volume loss (mediastinal shift; elevated left hemidiaphragm) and loss of border with mediastinum.
Early consolidation in left lower zone, and linear atelectasis in right lower zone.
Suggestion of subdiaphragmatic gas by right costophrenic angle (but not present on later studies).
The patient was admitted for antibiotic therapy and pulmonary rehabilitation.
As the disease course progressed, the patient required nutritional support with nasogastric feeding. A CXR was requested as no aspirate was gained.
The nasogastric tube is seen passing into the left bronchial system. This must be removed as soon as possible.
There is loss of the left hemidiaphragm suggesting further consolidation/collapse of the left lower lobe.
This follow up film after a week's therapy shows resolution of the left sided opacities, with a little scarring in the left upper zone and no early complications from the misplaced NG tube.
Case Discussion
This shows a number of important signs in acute chest imaging.
The most dangerous sign is the misplaced nasogastric tube. If this is used for feeding, the patient is at direct risk of aspiration or death. There is an expectation that when this is seen, the tube must be removed, ideally in the radiology department as soon as the study is reviewed.
There are also signs of the changes of volume loss and lobar collapse associated with acute pneumonia.
Unable to process the form. Check for errors and try again.