Presentation
History of immobility due to stroke, presented with "coffee ground" emesis for 1 day. Nasogastric tube was placed.
Patient Data
1. The NG tube is seen terminating in the left mainstem bronchus and is malpositioned.
2. No discrete focal consolidation, large effusion, or pneumothorax
Case Discussion
Radiographic assessment of nasogastric (NG) tube position is useful after NG tube placement. Chest x-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 esophagus (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 hemorrhage 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, MD
Health Sciences Clinical Professor,
Department of Radiological Sciences,
David Geffen School of Medicine at UCLA.
Attending Radiologist,
Olive View - UCLA Medical Center.
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