Images in Clinical Medicine
Pneumothorax — An Uncommon Complication of a Common Procedure
N Engl J Med 2010; 363:462July 29, 2010
- Article
A 92-year-old woman was admitted to the hospital with a severe left-sided ischemic stroke causing altered mental status (i.e., a score of 9 on the Glasgow Coma Scale, on which scores range from 3 to 15, with higher scores indicating increased consciousness), weakness on the right side, and dysphagia. An initial attempt to insert a small-caliber nasogastric tube for feeding was unsuccessful, with coiling of the tube in the mouth. A subsequent attempt with a stiff stylet resulted in easy insertion, without cough or respiratory distress. While awaiting radiography to confirm positioning of the tube, the patient had shortness of breath and was found to have decreased air movement in the right lung. Chest radiography revealed the tip of the nasogastric tube lying in the pleural space in the presence of a large pneumothorax on the right side (arrow). The nasogastric tube was removed immediately, but the patient died before further intervention. Though nasogastric tubes are generally considered safe, there is a risk of substantial pulmonary complications from blind insertion of small-caliber nasogastric tubes with a stiff stylet, particularly in patients with a reduced Glasgow Coma Scale score.
Tahir Nazir, M.R.C.P.
Shuja Punekar, F.R.C.P.
Royal Preston Hospital, Preston, United Kingdom
drtahirnazir@hotmail.com
