Misplaced nasogastric tube resulting in pneumothorax

Case contributed by Sophie Gregory
Diagnosis almost certain


Sudden onset dyspnea following nasogastric tube insertion.

Patient Data

Age: 70 years
Gender: Female

Initial CXR following...


Initial CXR following nasogastric tube insertion

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.

CXR following removal of...


CXR following removal of initial nasogastric tube & insertion of 2ndnasogastric tube

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

CXR following insertion of...


CXR following insertion of intercostal catheter

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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