This is a good learning case on the position of the nasogastric tube position.

On the initial radiograph post-insertion, the distal tube is malpositioned. This should prompt further investigation into the cause - usually by a limited CT, (depending on the local policy), or removal and re-insertion following a discussion with the primary clinician.

Following starting the feeding regime, the patient desaturated and became unwell, the radiograph demonstrating a feed related pleural effusion.

The CT then revealed the NG tube was malpositioned from the onset, the perforation likely occurring in the pharynx, above the limit of the scan. This then coursed along the posterior mediastinum to end in the right diaphragmatic recess.