Hydropneumothorax as an iatrogenic complication after nasogastric intubation

Description

A 62-year-old woman with history of frontotemporal dementia was admitted to a Psychiatry ward due to severe insomnia. In the morning, after the admission a nasogastric tube was placed to initiate enteral feeding and medication since she was refusing all oral intake. Later that night, she was found unresponsive, dyspnoeic and with severe hypotension. Physical examination identified clinical signs of respiratory distress and decreased vesicular breath sounds on the right hemithorax. The gasometric evaluation revealed the presence of hypoxaemia and lactic acidosis. A posteroanterior chest radiograph showed a right pleural effusion and a misplaced nasogastric tube (figure 1). A thoracic CT scan revealed the presence of a right hydropneumothorax and also identified a tube inside the trachea and the right main bronchus, which perforated the lung parenchyma and ended in the pleural cavity (figure 2).

Figure 1

Posteroanterior chest radiograph showing...

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