Nasogastric tube in left lower lobe with pneumothorax

Case contributed by Dr Andrew Dixon

Presentation

Chest pain and shortness of breath. Check for the nasogastric tube position.

Patient Data

Age: 85 years
Gender: Female

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Malpositioned nasogastric tube which passes into the left lower lobe and deep into the costophrenic recess.

Tiny left apical pneumothorax and larger right-sided pneumothorax were thought to be iatrogenic related to multiple unsuccessful attempts of NG tube insertion.

Bilateral pleural effusion and left lower lobe atelectasis are also present. 

Case Discussion

This case emphasizes three things:

  • seeing the NGT tip below the hemidiaphragm on a frontal image does not imply it is within the abdomen
  • a normally placed NGT should always pass through the diaphragm close to the midline
  • pushing an NGT into the lung is traumatic and can cause pneumothorax  

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