Nasogastric tube terminating in left bronchus
Diagnosis certain
Disclosures
- updated 19 Aug 2022:
Nothing to disclose
Updates to Case Attributes
Presentation
was changed:
Body
was changed:
Radiographic assessment of nasogastric (NG) tube position is useful after NG tube placement. Chest XRx-ray is the fastest and cheapest way to check for NG tube malposition in all patients, including those in the ICU 3.
A malpositioned tube may have its tip in the oesophagus (instead of in the stomach) or, more critically, in the trachea or bronchi. In this case, the NG tube terminates in the left main bronchus. If feeding or suction were initiated, aspiration pneumonia, pneumothorax or haemorrhage would be likely complications. Tube feeding into the lungs can lead to death 1. Due to its position, most malpositioned NG tubes in the airway end up in the right bronchus, specifically the lower lobe 3.
This case was submitted with supervision and input from:Soni C. Chawla, M.D.MDHealth Sciences Clinical Professor,Department of Radiological Sciences,David Geffen School of Medicine at UCLA.Attending Radiologist,Olive View - UCLA Medical Centre.
-<p>Radiographic assessment of <a href="/articles/nasogastric-tube-positioning">nasogastric (NG) tube position</a> is useful after NG tube placement. <a href="/articles/nasogastric-tube-position-on-chest-x-ray-summary">Chest XR </a>is the fastest and cheapest way to check for NG tube malposition in all patients, including those in the ICU <sup>3</sup>.</p><p>A malpositioned tube may have its tip in the oesophagus (instead of in the stomach) or, more critically, in the trachea or bronchi. In this case, the NG tube terminates in the left main bronchus. If feeding or suction were initiated, <a href="/articles/aspiration-pneumonia">aspiration pneumonia</a>, pneumothorax or haemorrhage would be likely complications. Tube feeding into the lungs can lead to death <sup>1</sup>. Due to its position, most malpositioned NG tubes in the airway end up in the right bronchus, specifically the lower lobe <sup>3</sup>. </p><p><em>This case was submitted with supervision and input from:<br>Soni C. Chawla, M.D.<br>Health Sciences Clinical Professor,<br>Department of Radiological Sciences,<br>David Geffen School of Medicine at UCLA.<br>Attending Radiologist,<br>Olive View - UCLA Medical Centre.</em></p>- +<p>Radiographic assessment of <a href="/articles/nasogastric-tube-positioning">nasogastric (NG) tube position</a> is useful after NG tube placement. <a href="/articles/nasogastric-tube-position-on-chest-x-ray-summary">Chest x-ray </a>is the fastest and cheapest way to check for NG tube malposition in all patients, including those in the ICU <sup>3</sup>.</p><p>A malpositioned tube may have its tip in the oesophagus (instead of in the stomach) or, more critically, in the trachea or bronchi. In this case, the NG tube terminates in the left main bronchus. If feeding or suction were initiated, <a href="/articles/aspiration-pneumonia">aspiration pneumonia</a>, <a title="Pneumothorax" href="/articles/pneumothorax">pneumothorax</a> or <a title="Pulmonary haemorrhage" href="/articles/pulmonary-haemorrhage">haemorrhage</a> would be likely complications. Tube feeding into the lungs can lead to death <sup>1</sup>. Due to its position, most malpositioned NG tubes in the airway end up in the <a title="Right main bronchus" href="/articles/right-main-bronchus-1">right bronchus</a>, specifically the lower lobe <sup>3</sup>. </p><p>This case was submitted with supervision and input from:<br>Soni C Chawla, MD<br>Health Sciences Clinical Professor,<br>Department of Radiological Sciences,<br>David Geffen School of Medicine at UCLA.<br>Attending Radiologist,<br>Olive View - UCLA Medical Centre.</p>
References changed:
- 1. Blumenstein I, Shastri Y, Stein J. Gastroenteric Tube Feeding: Techniques, Problems and Solutions. World J Gastroenterol. 2014;20(26):8505-24. <a href="https://doi.org/10.3748/wjg.v20.i26.8505">doi:10.3748/wjg.v20.i26.8505</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25024606">Pubmed</a>
- 2. Sigmon D & An J. Nasogastric Tube. StatPearls [Internet] 2022. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/32310523">Pubmed</a>
- 3. Bankier A, Wiesmayr M, Henk C et al. Radiographic Detection of Intrabronchial Malpositions of Nasogastric Tubes and Subsequent Complications in Intensive Care Unit Patients. Intensive Care Med. 1997;23(4):406-10. <a href="https://doi.org/10.1007/s001340050348">doi:10.1007/s001340050348</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/9142579">Pubmed</a>
- Blumenstein I, Shastri Y, Stein J. Gastroenteric Tube Feeding: Techniques, Problems and Solutions. World J Gastroenterol. 2014;20(26):8505-24. <a href="https://doi.org/10.3748/wjg.v20.i26.8505">doi:10.3748/wjg.v20.i26.8505</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25024606">Pubmed</a>
- Sigmon D & An J. Nasogastric Tube. StatPearls [Internet] 2022. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/32310523">Pubmed</a>
- Bankier A, Wiesmayr M, Henk C et al. Radiographic Detection of Intrabronchial Malpositions of Nasogastric Tubes and Subsequent Complications in Intensive Care Unit Patients. Intensive Care Med. 1997;23(4):406-10. <a href="https://doi.org/10.1007/s001340050348">doi:10.1007/s001340050348</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/9142579">Pubmed</a>
Unable to process the form. Check for errors and try again.