IS Case 336: Tracheobronchial malposition of the NG tube with pneumothorax

Veniamin Barshay, MD

Imaging Sciences URMC 2009
Publication Date: 2009-09-16

History

Patient is a 92-year-old female status post nasogastric (NG) tube placement.

Findings

The abdominal radiograph demonstrated a NG tube curled in the right hemithorax, consistent with airway placement with the tip in the pleural space. The follow up radiograph (Fig. 2) demonstrated right pneumothorax. The NG tube was repositioned in the stomach.

Diagnosis

Tracheobronchial malposition of the NG tube with pneumothorax

Discussion

Nasogastric intubation has become a standard of practice in the intensive care patient. There is inherent risk of malposition of the tube in the airways. The complications are potentially serious and include atelectasis, severe pneumonia, pneumo- and hemothorax. The frequency of the nasogastric tube malposition is difficult to evaluate. Various literature sources report it to be 0.5 to 1.5 % of the attempted intubations. The severity of potential complications illustrates the utility of appropriate placement confirmation by radiograph, when available.

References

Bankier AA, Wiesmayr MN, Henk C, et al. Radiographic detection of intrabronchial malpositions of nasogastric tubes and subsequent complications in intensive care unit patients. Intensive Care Med. 1997 Apr;23(4):406-10. PMID: 9142579