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Nasogastric tube in bronchi

Case contributed by Amanda Er

Presentation

Check for nasogastric tube position.

Patient Data

Age: 85 years
Gender: Male
X-ray

Initial presentation

The body of a thin bore feeding tube is coiled within the left main bronchus, which traverses the carina down the right main bronchus and into the right lower lobe. Removal and reinsertion is required.

Bronchiectatic changes in both mid to lower zones. No new focal consolidation or large pleural effusion. 

Old right 8th rib fracture.

X-ray

Final imaging

A wide bore feeding tube has been reinserted, with the tip overlying the gastric fundus.

Background bronchiectasis and scarring, predominately in both mid and lower zones. No new gross consolidation or pleural effusion.

Case Discussion

Anatomically, the right main bronchus is straighter than the left. Nasogastric tubes are hence more likely to be incorrectly advanced into the right main bronchus. In this case, the rare occurrence of the tube is inserted into the left main bronchus occurs before it coils and makes its way into the right main bronchus.

Care should always be taken when advancing a nasogastric tube. Feeding should not be carried out if imaging has not demonstrated the tube in the stomach 1. Complications from incorrect nasogastric tube positioning in the lower airway include aspiration pneumonia, pneumothorax, hemorrhage and empyema.

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Case information

rID: 75447
Published: 29th Mar 2020
Last edited: 30th Mar 2020
Inclusion in quiz mode: Included

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