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Case Reports: Learning from unexpected outcome (positive or negative)
Nasogastric tube placement perforating the nasopharynx causing mediastinal passage and feeding into the pleural space
  1. Muhammad Zafran1,
  2. Rebecca Crook2,
  3. Alexander Tuck2 and
  4. Atmadeep Banerjee2
  1. 1Respiratory Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  2. 2Gloucestershire Royal Hospital, Gloucester, Gloucestershire, UK
  1. Correspondence to Dr Muhammad Zafran; zafran_amc{at}yahoo.com

Abstract

A mid-60s female with known primary progressive multiple sclerosis was admitted to our hospital with aspiration pneumonia. Due to reduced consciousness, a nasogastric (NG) tube was inserted for feeding. A chest x-ray (CXR) report from a thoracic radiologist confirmed an atypical tip position due to a hiatus hernia but concluded it was almost certainly within the stomach. However, after deteriorating on feed commencement, a CT scan of the chest confirmed the tube had perforated the nasopharynx and run parallel to the oesophagus through the mediastinum into the right pleural space. The patient subsequently developed an empyema and pneumothorax, requiring multiple therapeutic interventions and a prolonged hospital stay. This case demonstrates how the routine insertion of an NG tube can lead to serious complications. Additionally, position check CXRs can be difficult to interpret, so the decision to use the tube must be made cautiously by the clinical team.

  • Empyema
  • Multiple sclerosis
  • Parenteral / enteral feeding
  • Pneumothorax
  • Pleural infection

https://doi.org/10.1136/bcr-2023-254771

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    Footnotes

    • Contributors The following authors were responsible for drafting the text, sourcing and editing clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: MZ, RC, AT and AB. The following authors gave final approval of the manuscript: MZ, RC, AT and AB.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.