[Iatrogenic tension pneumothorax following faulty positioning of gastric tube].

A 74-year-old man was admitted with respiratory insufficiency and required mechanical ventilation. Enteral nutrition was given via a nasogastric feeding tube, but persistent food retention occurred. The chest X-ray showed the nasogastric tube to be in the right pleural space. After the tube was withdrawn the patient developed a tension pneumothorax and a closed-tube thoracostomy was performed. The patient's recovery was uneventful, with resolution of the pneumothorax. It is necessary to be alert with respect to the tube position, which, if doubtful, should be checked by chest X-ray. Recognition of an aberrant position is necessary to minimize related morbidity.