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. 2022 Dec;12(4):167-173.
doi: 10.1177/19253621221137226. Epub 2022 Nov 18.

Fatal Enteral Nutritional Hydrothorax Resulting From Aberrant Placement of a Nasogastric Tube Without Perforation of the Tracheobronchial Tree or Esophagus: A Case Report and Review

Kylie N Schindler, Amanda J Youmans

Fatal Enteral Nutritional Hydrothorax Resulting From Aberrant Placement of a Nasogastric Tube Without Perforation of the Tracheobronchial Tree or Esophagus: A Case Report and Review

Kylie N Schindler et al. Acad Forensic Pathol. 2022 Dec.

Abstract

Nasogastric feeding tubes are commonly used in medical practice to provide nutritional support to patients who cannot take in an adequate amount of food orally. Although rare, nasogastric tubes errantly placed into the respiratory tract may cause serious complications, including death. We present an unusual autopsy case of a fatal hydrothorax that consisted of the enteric feeding solution following placement of a small-bore feeding tube into the left lung, despite no perforation of the tracheobronchial tree or esophagus. Alternative mechanisms for the formation of an enteral nutritional hydrothorax in the absence of a perforation from a feeding tube can be explained by the properties of the fluid, increased alveolar permeability, and underlying lung damage.

Keywords: Autopsy; Enteral nutrition; Fatal hydrothorax; Feeding tube displacement; Forensic pathology.

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Conflict of interest statement

The authors, reviewers, editors, and publication staff do not report any relevant conflicts of interest.

Figures

Image 1
Image 1
Enteral nutritional hydrothorax at autopsy involving the left chest cavity, seen pooling into the abdomen only after opening of the chest, with a mediastinal shift and a collapsed left lung.
Image 2
Image 2
Enteral nutritional hydrothorax at autopsy seen filling the left chest cavity upon opening.
Image 3
Image 3
Left lung (posterior aspect) showing a patchy, thick exudate on the pleural surface. The right lung had no pleural exudate.
Image 4
Image 4
Tracheobronchial tree opened from a posterior approach with the left main bronchus containing a thick white-tan, milky substance admixed with mucus. No enteric fluid grossly entered the right lung.
Image 5
Image 5
Cut section of the left lung showing the same thick white-tan, milky substance in a distal bronchial branch.
Image 6
Image 6
Left lung with organizing diffuse alveolar damage and accumulation of a wispy, proteinaceous substance.
Image 7
Image 7
Left lung bronchial branch with denudation of the mucosa and accumulation of a wispy, proteinaceous substance within the lumen.
Image 8
Image 8
Pleural surface of the left lung with the adherent, wispy, eosinophilic staining proteinaceous substance layered over the pleura with a neutrophilic infiltrate.
See this image and copyright information in PMC

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