Presentation
This patient was admitted to the hospital after a fall at home in which he suffered a small subarachnoid hemorrhage and, above all, a fracture of C1 and C2 (Jefferson fracture). In order to establish enteral feeding, insertion of a nasogastric tube was performed.
Patient Data
Abnormal location of the nasogastric tube traversing along the course of the trachea and the right main bronchus into the right upper abdomen. There are a small apical right-sided pneumothorax and a well-defined band shaped opacity in the medial right lower zone suspicious of atelectasis (differential diagnosis aspiration or hemorrhage).
The feeding tube was immediately removed.
Non-contrast CT post-NG-removal shows the presence of a significant right pneumothorax and extensive atelectasis at the right base; pleural effusion is seen.
The site of iatrogenic lung and diaphragm laceration is not recognisable with certainty.
Mild basal atelectasis controlateral is present in this long-suffering patient.
Case Discussion
Nasogastric placement is a frequently performed procedure for hospitalized, particularly critically ill patients, and although it seems a simple procedure, it may carry potential life-threatening complications due to misplacement.
Chest X-ray after insertion of the NG tube is considered a gold standard to assess the right positioning in the stomach.
The case illustrates some of the complications that can occur in case of feeding tube misplacement.
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