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Malpositioned nasogastric tube

Case contributed by M Ravi Krishna
Diagnosis certain

Presentation

A patient with a history of bronchial asthma and rheumatic heart disease post mitral valve replacement was admitted to our intensive care unit. Ventilatory mechanics revealed a high peak inspiratory pressure and circuit leak of 34% . Clinical examination revealed a fixed monophonic wheeze in the right mammary area.

Patient Data

Age: 50 years
Gender: Male
x-ray

A frontal projection X -ray showed apparent cardiomegaly with a metallic mitral valve. prominent bronchovascular markings were noted. Central venous catheter is insitu. Endotracheal tube tip was just located above the level of carina. Nasogastric tube appears malpositioned with its tip lying in the right lower lobe bronchus

Case Discussion

The insertion of nasogastric tube insertion has been considered as being an easy and mostly uneventful procedure. The incidence of pulmonary complications reported from nasogastric tube insertion is around 2%. Malpositioned nasogastric tubes causing complications such as pneumothorax, pleural effusion, retropharyngeal abscess and lung abscess have all been reported in the literature.

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