A Misplaced Nasogastric Tube!

Misplaced Nasogastric Tube in the right hemithorax

A case of misplaced nasogastric tube in a 75-year-old patient with severe Alzheimer’s disease.

A 75-year-old female patient presented to the emergency department with progressive dyspnoea for the past 48 hours. The patient was a known case of severe Alzheimer’s disease; therefore, she was totally dependent on nasogastric tube feeding (NGT). Later she was diagnosed with a misplaced nasogastric tube.

On physical examination, auscultation revealed decreased air entry over the right lung. Percussion revealed dullness.

Two days before hospital presentation, a junior doctor had changed her nasogastric tube and performed a post-NGT chest X-ray to confirm the position. The doctor then discharged the patient to the nursing home.

During the current presentation, the physician performed a thoracic bedside ultrasound which demonstrated right pleural effusion.

A plain radiograph of the chest showed a misplaced NGT in the right pleural space and hydropneumothorax.


The surgeons removed the nasogastric tube immediately. After that, they inserted a thoracic drainage tube obtaining 1200 mL of enteral nutrition. There were no complications after the procedure. Her hospital course was satisfactory.

Enteral nutrition obtained after thoracentesis

Since there were no complications, the doctors discharged the patient 7 days later.

Resolution of hydropneumothorax after thoracentesis.

Although nasogastric tube insertion is usually blindly performed, the rate of complications is low. Blind insertion complications may vary between 0.3 to 15%, otherwise, NGT insertion in generally safe, easy, and inexpensive. Some of the complications include misplacement, aspiration pneumonia, hydrothorax, haemothorax, empyema and delayed pneumothorax.

Misplaced NG tube may not be predictable by the physical examination; therefore, post-NGT chest X-ray is a gold standard confirmatory test.

Plain chest Xray and chest computed tomography scan are sufficient for diagnosing the complications.

Thoracic drainage is the technique of choice. When drainage remains insufficient, additional chest tubes may be required. At times, patients may require bronchoscopy too to aspirate the feeding contents.


Alonso JV, del Pozo FJF, Aguayo MA, Pedraza J (2016) The Real Risks of Nasogastric Tubes: “Nutrothorax” Complicating a Misplaced Nasogastric Feeding. Clin Med Img Lib 2:032. doi.org/10.23937/2474-3682/1510032

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.


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