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Nasogastric tube insertion (NGT) is a common bedside procedure and malpositioned tubes into the tracheobronchial are not uncommon. These can be associated with pulmonary complications. Significantly, pneumothoraces are rare but potential complications that clinicians need to be aware of. We herein report a case of pneumothorax following NGT insertion that necessitated operative management. A 72-year-old male smoker was undergoing rehabilitation after a recent cerebrovascular accident. A NGT change was done and the chest radiograph done to check placement demonstrated the NGT in the right bronchus with the tip in the right pleural space. The NGT was removed and a new one reinserted. A repeat chest radiograph demonstrated a right sided pneumothorax. He underwent radiologically guided chest drain insertion and subsequently required thoracoscopic surgery where a wedge resection of the right lower lobe was performed. The chest drain was removed on day two post operatively and he made an uneventful recovery.

From: Ivan Kuang Hsin Huang, MBBS, MMed, FRCR Mahendran Nadarajah, MBBS, FRCR Li Tserng Teo, MBBS, FRCS Dokev Basheer Ahmed Aneez Ahmed, MBBS, FRCS, FAMS Uei Pua, MBBS, MMed, FRCR, FAMS Department of Diagnostic Radiology (I.K.H.H., U.P.); Trauma and Acute Care Surgery Service, Department of General Surgery (L.T.T.); and Thoracic Surgery and Thoracic Oncology Service, Department of General Surgery (D.B.A.A.A.) Tan Tock Seng Hospital 11 Jalan Tan Tock Seng Singapore 308433; and Department of Diagnostic and Interventional Neuroradiology (M.N.) National Neuroscience Institute Singapore

With breast cancer awareness, the incidence of large invasive tumours is rare. We present a video of locally advanced breast cancer invading the anterior chest wall requiring en bloc resection that resulted in a large chest wall defect with exposed pleural and pericardial surface. Skeletal reconstruction and provision of adequate soft tissue coverage in order to avoid respiratory failure was challenging. A 58-year-old female presented with a 3-year history of locally invasive breast carcinoma with contiguous spread to sternum, clavicles, sternoclavicular joints and bilateral second to fifth ribs. She underwent total sternectomy, bilateral second to fifth ribs and chest wall resection resulting in a 21 × 18 cm chest wall defect. Reconstruction of her sternum was with methyl-methacrylate cement prosthesis. Ribs were reconstructed with titanium plates. Soft tissue coverage was achieved with left vertical rectus abdominis pedicle flap, right external oblique transposition flap and a right latissimus dorsi free flap. Flap failure necessitated a right vastus lateralis free flap. She was discharged ambulant without respiratory compromise. Resection and reconstruction of large chest wall defects is possible due to new bioprosthetic materials and is possible with acceptable morbidity and mortality.