Endobronchial nasogastric tube with lobar collapse

Case contributed by Dr Derek Smith

Presentation

Admitted with shortness of breath and fever. Added sounds in left chest.

Patient Data

Age: 70
Gender: Male

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.

X-ray

Nasogastric tube position check

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.

X-ray

Follow up film (1 week)

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.

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Case information

rID: 39512
Case created: 7th Sep 2015
Last edited: 15th Sep 2015
Inclusion in quiz mode: Included

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