CTICasesIatrogenic Tracheal-Esophageal Fistula / Diaphragmatic Perforation (Malpositioned Feeding Tube)
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Imaging findings
Routine post-operative chest radiograph after cardiac valvular surgery, initially subtle, shows a feeding tube that is not descending correctly. A subsequent abdominal radiograph on the same day clearly shows the feeding tube path to be extra-luminal, with abnormal gas consistent with subcutaneous emphysema and/or retroperitoneal air extending towards the hip joint. Operative reports indicate the tube perforated the lung, pleural space, diaphragm, and injured bowel.
Key takeaways
This is a severe iatrogenic complication of feeding tube placement, resulting in perforation of the lung, pleura, diaphragm, and bowel, leading to pneumomediastinum, pneumothorax, and extensive intra-abdominal/retroperitoneal air. Vigilant review of feeding tube position on initial radiographs is critical, even for subtle deviations.
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