Editor-A nasogastric tube (NT) is commonly used to empty the stomach and to monitor the occurrence of bowel occlusion after major abdominal surgery. The incidence of misplacement of NTs into the airways ranges between 0.3% and 15% and is associated with significant morbidity and mortality.A 44-yr-old woman with a history of diabetes and obesity (BMI 50 kg m~(-2)) underwent gastric bypass. During surgery, an NT was inserted into the oesophagus through the nose to check for the absence of digestive fistula by administering 150 ml of methylene blue stain. No abnormality was noted during the procedure. At extubation, methylene blue stain was noted in the tracheal aspiration. Tracheal examination with ultrasound was used to check for misplacement of NT. A 5-10 MHz linear ultrasonography transducer (Vivid?, General Electric, UK) was placed transversely on the anterior neck just above the suprasternai notch as described by Ma and colleagues.The presence of a hyperechoic artifact of the trachea ring (Fig. 1a, large arrow) and an abnormal hyperechoic artifact inside the trachea with posterior shadowing much narrower than usually generated by the trachea (Fig. 1a, dotted arrow) were suggestive of the presence of the NT in the trachea. The incorrect positioning of the NT was confirmed by chestX-ray. After NT removal, ultrasound examination of the trachea was normal with a periodic resonance artifact and posterior shadowing behind the trachea ring (Fig. 1b, small arrows).
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