Misplaced nasogastric tube resulting in pneumothorax

Case contributed by Dr Sophie Gregory

Presentation

Sudden onset dyspnea following nasogastric tube insertion.

Patient Data

Age: 70 years
Gender: Female

Initial chest x-ray following nasogastric tube insertion

X-ray

Nasogastric tubing is projected over right chest and head, not conforming to the configuration of the GI tract. Patchy airspace opacities in the left lower zone favoring infectious/inflammatory etiology.

Chest x-ray following removal of initial nasogastric tube and insertion of second nasogastric tube

X-ray

Moderate to large right pneumothorax. Nasogastric tube tip projected over stomach. Old healed left rib fractures.

Chest x-ray following insertion of intercostal catheter

X-ray

Persistent moderate right pneumothorax. Intercostal catheter in situ with tip projected over right hilar region. Subcutaneous emphysema right lateral chest. Opacities in right lung likely representing collapse. Nasogastric tube in situ with tip projected over stomach. Supplemental oxygen tubing projected over right chest.

Case Discussion

Nasogastric tube malplacement is thought to be more common in patients with impaired swallow coordination 1, which this patient had following an acute ischemic stroke.

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