Nasogastric tube in left lower lobe with pneumothorax

Case contributed by Dr Andrew Dixon

Presentation

Check of nasogastric tube. Chest pain and short of breath.

Patient Data

Age: 85
Gender: Female

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

Case Discussion

Malpositioned nasogastric tube which passes into the left lower lobe and deep into the costophrenic recess. This case emphasises three things; that seeing the NGT tip below the hemidiaphragm on a frontal image does not imply it is within the abdomen, that a normally placed NGT should always pass through the diaphragm close to the midline and that pushing an NGT into the lung is traumatic and can cause pneumothorax.  

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Case information

rID: 39511
Case created: 7th Sep 2015
Last edited: 10th Nov 2016
System: Chest
Inclusion in quiz mode: Included

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