An 85-year-old woman with failure to thrive due to poor oral intake was admitted owing to dehydration. A nasogastric (NG) tube was inserted for the initiation of enteral feedings. The tube position was confirmed by gastric auscultation after insufflating air through the tube. A chest X-ray revealed that the NG tube traversed the right main stem bronchus with its tip ending in the right costophrenic angle adjacent to the pleura. No pneumothorax was identified. The tube was removed and a short while later the patient developed mild chest discomfort. A repeat chest X-ray revealed significant pneumothorax on the right side. She was treated conservatively with 100% oxygen with successful resolution of the pneumothorax.
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