IS case 492: Iatrogenic pneumothorax

Neal Young, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-08-30

History

Patient is a critically ill 88-year-old male who developed respiratory distress after nasogastric (NG) tube placement.

Findings

See images

Diagnosis

Iatrogenic pneumothorax

Discussion

Accidental tracheobronchial placement of an NG tube can cause pneumothorax. In a single center study, up to 27% of intrabronchial tube placement cause a pneumothorax. Overall, about 0.1% of placements result in pneumothorax. Repeated misplacement increases the chance of pneumothorax. The gold standard for verification of feeding tube position is a chest radiograph. One caveat to be aware of is that left lower intrabronchial placement can mimic placement in the stomach in patients that are difficult to position for a proper radiograph. Often, as in this case, the ordering clinician instead requests an abdominal radiogra

References

1. Marderstein EL, Simmons RL, Ochoa JB. Patient safety: effect of institutional protocols on adverse events related to feeding tube placement in the critically ill. J Am Coll Surg. 2004 Jul;199(1):39-47; discussion 47-50. PMID: 15217627