Pediatric Feeding Tube Malfunction / Malposition / Misposition / Misplacement

Etiology: Placed in patients who have trouble eating to provide nutrition
Imaging AXR AP:
— A feeding tube tip that crosses to the right of the spine and then heads superiorly before turning back to the left of the spine is most likely still in the stomach
— A feeding tube tip that crosses to the right of the spine and then heads inferiorly before turning back to the left of the spine is most likely in the duodenum or jejunum
— Feeding tube tip should be transpyloric in position, ideally near the duodenal-jejunal junction or in the proximal jejunum
Imaging AXR Lateral: Can help to confirm retroperitoneal location of a post-pyloric feeding tube
DDX:
Complications:
— Placement of the feeding tube tip into the airway can result in pneumothorax or aspiration with feedings
— Perforation of the gastrointestinal tract during feeding tube placement
— Placement of the feeding tube tip proximal to the duodenal-jejunal junction
— Kinking of the feeding tube tip leading to its obstruction
— Pulling back of the feeding tube tip into the stomach
— Migration of the feeding tube tip out of the duodenum
Treatment: Further advancement of proximally placed feeding tube, replacement of kinked feeding tube
Clinical: Presentations include what is being infused though the feeding tube is being aspirated out of a nasogastric tube in the stomach or inability to infuse through feeding tube

Radiology Cases of Feeding Tube Malfunction / Malposition / Misposition / Misplacement

Radiology Cases of Correct Placement of the Feeding Tube Into the Proximal Jejunum

AXR with feeding tube tip in proximal jejunum — AXR shows a feeding tube coursing along the greater curvature of the stomach and then passing through the pylorus and duodenum with the tip in the proximal jejunum. A nasogastric tube is also present with its tip within the body of the stomach.

AXR of feeding tube in appropriate position in the proximal jejunum — AXR AP shows the tip of the nasogastric tube is in the stomach. The tip of the feeding tube is seen to cross the midline through the pylorus, descend through the duodenum, and then course through the proximal jejunum.

AXR of normal position of the tip of the feeding tube in the proximal jejunum — AXR AP shows a feeding tube that appears to loop back upon itself within the stomach before it exits through the pylorus and courses through the duodenum with its tip in the proximal jejunum.

Radiology Cases of Aneurysmal Dilation of Feeding Tube

CXR of aneurysmal dilation of feeding tube — CXR AP shows a feeding tube with its tip projecting over the proximal jejunum. Incidentally noted is an aneurysmal dilation of the feeding tube just beneath the level of the thoracic inlet.

Radiology Cases of Feeding Tube Placement Into Airway

CXR of feeding tube in right mainstem bronchus — CXR AP shows a tracheostomy tube in normal position. There is a feeding tube present whose tip projects within the right mainstem bronchus

AXR of feeding tube tip in the left mainstem bronchus — Initial AXR (left) shows the tip of the feeding tube in the left mainstem bronchus. Subsequent AXR after feeding tube repositioning (right) shows the feeding tube tip to be in the fundus of the stomach.

AXR of feeding tube in mainstem bronchus, lung and pleural space with tension pneumothorax — AXR obtained immediately after feeding tube placement (left) shows a feeding tube going down the left mainstem bronchus and then turning up into the lung and increased lucency in the left costophrenic angle presumably due to the feeding tube entering the left pleural space. AXR obtained a minute later after feeding tube repositioning (right) shows the tip of the feeding tube in the antrum of the stomach and a large left pleural air collection with mediastinal shift to the right.

Radiology Cases of Feeding Tube Placement Into Esophagus

CXR of feeding tube tip malposition in the cervical esophagus — CXR AP shows a feeding tube which courses into the stomach and then loops back upon itself and reenters the esophagus and whose tip lies at the level of C6.

AXR of feeding tube with tip in the esophagus — AXR shows a feeding tube entering the stomach and then looping back upon itself into the proximal esophagus.

Radiology Cases of Feeding Tube Placement Into Stomach

AXR with feeding tube tip in the stomach — AXR shows a feeding tube coursing along the greater curvature of the stomach with the tip looping back upon itself in the body of the stomach. A nasogastric tube is also present with its tip within the body of the stomach.

Radiology Cases of Feeding Tube Placement Into Duodenum

AXR with feeding tube tip in the first part of the duodenum — AXR shows a feeding tube coursing along the greater curvature of the stomach and then passing through the pylorus with the tip in the first part of the duodenum. A nasogastric tube is also present with its tip within the body of the stomach.

AXR with feeding tube tip in the second part of the duodenum — AXR shows a feeding tube coursing through the stomach and then passing through the pylorus with the tip in the second part of the duodenum. A nasogastric tube is also present with its tip within the fundus of the stomach.

AXR of feeding tube tip in third part of duodenum — AXR shows a feeding tube coursing along the greater curvature of the stomach and then passing through the pylorus and duodenum with the tip in the third part of the duodenum. A nasogastric tube is also present with its tip within the body of the stomach.

Radiology Cases of Feeding Tube Position That Looks Correct But That Is Not Correct

AXR of feeding tube tip in stomach — AXR AP (above) shows a feeding tube that crosses to the right of the spine and then heads inferiorly before turning back to the left of the spine with its tip projecting in the left upper quadrant and this is also demonstrated on the pre-tube injection scout image (below left). Injection of contrast through the tube (below right) showed the tip was in the stomach.

Radiology Cases of Kink in the Feeding Tube

AXR of kink in feeding tube — AXR AP shows the tip of the nasogastric tube to be in the body of the stomach. The tip of the feeding tube is transpyloric in position at the duodenal jeujunal junction. However, the feeding tube lumen is kinked in the body of the stomach.

Radiograph of kinked feeding tube — AXR AP shows the tip of the feeding tube to be at the duodenal-jejunal junction. In the antrum of the stomach the feeding tube is curled back upon itself and kinked at this location.

Radiology Cases of Feeding Tube Tip That Has Been Pulled Back Into Stomach

AXR of feeding tube tip in stomach — AXR AP (above) shows a feeding tube that crosses to the right of the spine and then heads inferiorly before turning back to the left of the spine with its tip projecting in the left upper quadrant and this is also demonstrated on the pre-tube injection scout image (below left). Injection of contrast through the tube (below right) showed the tip was in the stomach.

Radiology Cases of Feeding Tube Migration Out of Duodenum

US of feeding tube tip in main portal vein — Transverse US of the liver shows the echogenic tip of a feeding tube to be in the main portal vein in the center of the image. Note the posterior shadowing from the tip extending inferiorly from it.