Fatal hydrothorax due to misplacement of a nasoenteric feeding tube

Blind nasoenteric intubation was attempted in a patient with chronic parkin sonism. The tube was inadvertently misplaced and penetrated the left pleura l cavity. The next day, the patient developed cardiopulmonary arrest during dietary supplement infusion. This complication ultimately led to the patie nt's death. We have reviewed the known complications of nasoenteric tube pl acement and conclude that difficult insertion in patients at risk from tube misplacement should be followed by chest radiography to confirm the correc t placement of the tube before nutritional support is started.