Iatrogenic empyema secondary to the malposition of a nasogastric tube

Blind NGT insertion can lead to tube misplacement into the respiratory tract. This can lead to multiple pulmonary complications including lung injury, pneumothorax, pneumonia, empyema and diaphragmatic injury. We present the case of an 80 year-old female who required an NGT insertion for severe oropharyngeal dysphagia from an acute stroke. Her admission was complicated by multiple pneumothoraces from repeated insertions, as well as the unusual complication of a recurrent nasogastric feeding-related empyema requiring multiple intercostal chest drain insertions for drainage. This case highlights the importance of careful NGT insertion and placement with imaging confirmation before use.