Fatal hydrothorax and empyema complicating a malpositioned nasogastric tube

Blind nasogastric intubation was attempted in a chronically debilitated patient. The nasogastric tube entered the trachea and was advanced through the left lower lobe bronchus into the left pleural cavity. During the subsequent two days of dietary supplement (Isocal) infusion, the patient developed fever, chills, decreased responsiveness, and left shoulder pain. This complication ultimately led to the patient's death. We have reviewed the known complications of nasogastric intubation and recommend that difficult intubations in weak or debilitated patients be followed by chest roentgenogram in order to confirm the correct placement of the tube.